ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

LABOR

Hypertonic Uterine Contractions

Process of Moving Out of Amniotic Fluid, Fetus,
-​ Excessively strong or frequent contractions of
Placenta, and Fetal Membranes.
the uterus during labor.
Theories of Labor:
1.​ Mechanical Theory Uterine Contractions
○​ Efficiency, speed, and productivity are ●​ Finger crowding can be spread slightly over
key. the fundus during contractions.
○​ Parts of a system perform repetitive
tasks to produce output. Hypotonic Phases of Contractions
2.​ Hormonal Theory
1.​ Increment (Building Phase)
○​ Role of hormones
■​ Releases certain hormones like ○​ Contraction begins.
oxytocin, progesterone, and 2.​ Acme (Peak Phase)
estrogen. ○​ Peak of the contraction.
■​ Parturient- women in labor. 3.​ Decrement (Relaxing Phase)
○​ Contraction decreases in intensity.​
Prodromal Signs of Labor:
1.​ Lightening (Sudden drop)
UC (Uterine Contractions)
2.​ Increased activity level/Splurt of energy.
3.​ Loss of energy. ○​ Beginning to end
4.​ Braxton Hicks contractions. ○​ Intensity: Strength of contractions
5.​ Ripening of the cervix. ○​ Frequency: How often contractions
occur
Signs of True Labor: ○​ Regularity: Whether contractions
1.​ Uterine contractions. are consistent or not​
2.​ Bloody show.
3.​ Rupture of membranes
Assessment of Fetus
Amniotic Fluid Tests: 1.​ LGA (Large for Gestational Age)
Urine Yellow a.​ More than 90%
Amniotic Fluid Blue 2.​ SGA (Small for Gestational Age)
●​ Nitrazine Test (pH test) a.​ Less than 10%
●​ Fernings’ Test (vaginal discharge)
3.​ AGA (Appropriate for Gestational Age)
a.​ 10% to 90%
POWER - Forces of Labor

●​ Primary: Uterine contractions.

○​ Involuntary
●​ Secondary: Maternal pushing.
○​ Voluntary
Uterus
●​ Upper: Active
Figure 1.1: Bones of the Fetal Skull​
●​ Lower: Passive
Bones of the Fetal Skull
Why Does Contraction Hurt? ●​ Frontal Bone (2)
●​ Pressure on the cervical opening and lower ●​ Parietal Bones (2)
part of the uterus. ●​ Temporal Bones (2)
●​ Uterus contracting and tightening. ●​ Occipital Bone (1)
●​ Force of the fetus' head pressing on the ​
cervix. Fetal Skull Measurements

EFFACEMENT - Thinning and stretching of the ●​ 9.5 cm Diameter: Biparietal diameter

cervix. ●​ 10 cm Diameter - ??
DILATION - Opening of the cervix during labor.
0 cm - closed​ Sutures and Membranous Tissues:
​ 10 cm Fully Dilated
●​ Metopic (Frontal Bone)
pg.1 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Sagittal (Parietal Bones) 4.​ Loose Connective Tissue
●​ Coronal (Frontal & Parietal Bones) 5.​ Pericranium
●​ Lambdoidal (Parietal & Occipital Bones)
PRESENTATION
Fontanels (Soft Spots):

●​ Anterior Fontanel: Part of the lower fetus in the lower pole.

○​ Located at the front of the baby’s
head
○​ Diamond or kite-shaped
●​ Posterior Fontanel:
○​ Located at the back of the baby’s
head
○​ Triangular shape
●​ Temporal Fontanel:
○​ Located on the side of the head Figure 1.4: Types of Presentation​
○​ L-shaped ​
Compound Presentation:
Bregma- The large fontanel located at the top of
the head. ●​ Arm or hands are positioned alongside the
presenting part.

​
Figure 1.2: Fetal Head Measurements

Fetal Head Measurements

●​ Mento-Vertical: 14 cm (Largest
Figure 1.5:Types of Breech Presentation
measurement)
●​ Occipito-Frontal: 11.5 cm 1.​ Frank Breech:
●​ Suboccipito-Frontal: 9.5 cm ○​ The baby’s buttocks are presenting first,
●​ Submento-Bregmatic: 9.5 cm with the legs extended upward towards
●​ Suboccipito-Bregmatic: 9.5 cm the head.
2.​ Complete Breech:
○​ The baby’s buttocks are presenting first,
with the legs bent at the knees, and the
feet near the buttocks.
3.​ Incomplete Breech (Footling Breech):
○​ One or both of the baby’s feet are
presenting first, with the legs extended
Figure 1.3: Fetal Head Shapes downward.

Fetal Head Shapes

●​ Cephalohematoma
○​ Extracranial edema
○​ Does not cross suture lines
●​ Caput Succedaneum
○​ Does cross suture lines

Layers of the Scalp

1.​ Skin Subcutaneous Tissue
2.​ Connective Tissue Figure 1.6: Fetal Heart Tone Best Heard
3.​ Aponeurosis
pg.2 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

Figure 1.8: Stations​

Station Measurements:
●​ 0: At the level of the ischial spines.
●​ -5 to -1: High in the pelvis.
●​ +1 to +3: Lower in the pelvis.
●​ +4: About to crown.
●​ +5: Reached Vagina
Figure 1.7:Fetal Positions

Fetal Presentation Types:

1.​ Vertex: Head downward (the most common

presentation).
Figure 1.9: RIng of Bandl’s​
○​ Military: Head straight (neutral
position).
Ring of Bandl's:
2.​ Mentum (Chin Downward): Chin is
●​ A danger sign indicating a potential rupture
downward during presentation.
of the lower uterine segment.
3.​ Breech: Buttocks first.
○​ Frank Breech: Buttocks first with
Types of Pelvis:
legs extended upward.
1.​ Sacral: Pelvic shape defined by the
○​ Complete Breech: Buttocks first
sacrum.
with legs bent at the knees.
2.​ Occipital: Related to the occipital part of
○​ Footling Breech: One or both feet
the fetal head.
presenting first.
3.​ Innominate: Refers to the pelvic bones that
4.​ Face Presentation: Baby’s face first (rare).​
are not specifically identified by a single
​
name.​
—
1.​ Fully Flexed: Chin is against the chest, with
Linea Terminalis
the head tucked into the chest.
-​ Separation of true & false pelvis
2.​ Partially Flexed: The head is partially
flexed.
Pelvic Inlet and Outlet:
3.​ Deflexed Presentation The fetal head is
●​ Conjugate: Measurement of the pelvic inlet.
not properly flexed during labor.
●​ Diagonal Conjugate: Measured from the
4.​ Extended: The head is extended backward.
sacral promontory to the pubic symphysis.
●​ Pelvic Inlet and Outlet: The boundaries
that define the space through which the
fetus must pass during delivery.
STATION
**Figure below for better understanding
The station refers to the position of the presenting
part of the fetus in relation to the maternal pelvis. Pelvic Inlet- Ending of linea terminalis (Conjugate)
Mid-Pelvic- between pelvic inlet and outlet
Outlet- bottom of pelvic bone

pg.3 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Ritgen's Maneuver:

●​ A technique used to assist in the delivery of

the baby’s head.
●​ Using an OS to extend the perineum to
prevent laceration

Stages of Delivery:
●​ Third Stage (Placental Stage):
○​ Begins with the delivery of the baby
and ends with the delivery of the
placenta.
Figure 1.10: Antero-Posterior Diameters
Dimination in Site of the Placental Site afterbirth
of the newborn
Boundaries of the Pelvic Inlet:
●​ Anterior: Pubic symphysis
A. Spatial Relation:
●​ Posterior: Sacral promontory
●​ Refers to the position and alignment of the
●​ Lateral: Iliac fossa​
placenta in relation to the uterus.
B. Partial Spatial Relation:
Diameter of Pelvic Outlet:
●​ Refers to partial adherence or positioning of
●​ Anterior-Posterior (AP) Diameter:
the placenta in relation to the uterine wall.
○​ Measurement from the pubic
symphysis to the sacral promontory.
Signs of Placental Separation:
●​ Transverse Diameter:
●​ Globular and Firmer Uterus:
○​ Measured across the pelvic outlet,
○​ Earliest to appear in Calkin’s Signs
side to side.
■​ Calkin’s Signs refer to specific signs
●​ Posterior-Sagittal Diameter:
used to detect the presence of
○​ Measured from the sacrum to the
placental separation or
pubic arch.
complications during the third stage
of labor, particularly regarding the
UMBILICAL CORD - 52-55 CM
delivery of the placenta.

SYNCLITISM

A position in which the fetal head is engaged such

that the sagittal suture of the fetal head is
equidistant from the pubic symphysis and sacrum Crede's Maneuver:
●​ Gentle pressure applied to the fundus of a
●​ In simple terms: The fetal head is parallel to
contracted uterus to aid placental delivery.
the pelvic plane, and the sagittal suture is
aligned with the midline.

Brandt-Andrews Maneuver:
●​ Manually rotating the placenta to help with
its expulsion.
Figure 1.11: Ritgen’s Maneuver
​

pg.4 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

Duncan Mechanism: Friedman’s Curve:

●​ The placenta detaches from the uterine wall ●​ A well-known graph used to assess labor
starting at its lower edge, causing the progression, particularly cervical dilation
maternal surface of the placenta to be and fetal descent.
delivered first. ●​ Identification of Normal Labor Progression
Patterns and Early Detection of Abnormal
Schultze Mechanism: Progression.
●​ Fetal surface of the placenta appears first
during placental separation. Sinoatrial Node:
●​ SA Node: Located in the right atrium.
Fourth Stage (Postpartum Stage): ●​ Labor -> No SA node
●​ Vigilant, Maternal, Homeostatic,
Stabilization Stage Labor Disorders:
●​ FIRST 1-4 HOURS MOST CRITICAL ●​ Advanced Maternal Age
BECAUSE OF UNSTABLE V/S. ●​ Obesity
●​ Overdistension of the Uterus
Puerperium / Postpartum Period: ●​ Abnormal Presentation
●​ The period following the birth of the baby. ●​ CPD (Cephalopelvic Disproportion)
It’s the recovery phase where the mother’s ●​ Overstimulation of the Uterus
body returns to its pre-pregnancy state. ●​ Maternal Fatigue, Dehydration, or Fever
●​ Lack of Analgesia or Anesthesia
Phlegmasia Alba Dolens
Milky whitey legs Common Causes of Dysfunctional Labor:
●​ Primigravida (First-Time Pregnancy)
Dystocia ●​ Pelvic Abnormalities or Narrow Pelvis
●​ Obstructed or difficult labor. ●​ Uterine Inertia (Failure of Uterine
●​ May involve conditions such as: Contractions)
○​ Premature Rupture of Membranes ●​ Posterior Presentation of Fetal Head
(PROM): Rupture of the amniotic (Occiput Posterior Position)
sac before labor begins. ●​ Failure of Uterine Contractions
○​ Rupture of Amniotic Sac: The
amniotic sac breaks before labor 3 P's of Dystocia:
starts. 1.​ Power: Abnormalities of uterine
contractions.
Preterm Labor 2.​ Passenger: Abnormalities of the fetus (size,
●​ When contractions cause the cervix to open position, etc.).
before 37 weeks of pregnancy. 3.​ Passage: Abnormalities of the birth canal
(pelvic shape or size).
Dystocia:
●​ Difficult or obstructed labor.
●​ Causes:
○​ Fetal Malpresentation
○​ Cephalopelvic Disproportion
(CPD)
○​ Maternal Obesity
○​ Abnormal Pelvic Shape or
Structure
○​ Epidural
pg.5 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
○​ Resting Tone: Less than 10 mmHg.
○​ Strength of Contractions: Does
CPD (Cephalopelvic Disproportion) not rise above 25 mmHg.
○​ The contraction strength may range
A condition where the baby’s head (cephalic) is too between 25–75 mmHg during the
large to pass through the mother’s pelvis (pelvic). active phase.

Monitoring Uterine Contractions:

Power Mechanism (Uterine Dysfunction):
●​ Internal Fetal Monitoring:
●​ Inadequate Contractions: The uterine
○​ A thin wire is inserted to monitor
contractions may be insufficiently strong to
uterine contractions accurately.
efface and dilate the cervix
○​ An intrauterine pressure catheter
●​ Maternal Factors (Voluntary Pushing):
(IUPC) is used to measure the
Second Stage of Labor: The mother’s
pressure inside the uterus, typically
voluntary pushing during labor may not be
used when external monitoring is not
effective, contributing to difficulty in fetal
sufficient.
descent.
●​ Pressure Measurements:
○​ If the resting tone increases to more
Contractions
than 15 mmHg, this may indicate an
Spontaneous uterine contractions occur unless
issue such as uterine
oxytocin is administered to stimulate them.
hyperstimulation.
Hypertonic Uterine Contractions:
Abnormalities of Expulsive Forces:
●​ Marked by:
●​ Primary (Hypertonic) Uterine
○​ An increase in uterine tone to more
Dysfunction:
than 15 mmHg, resulting in frequent
Uterine contractions are excessively strong,
and strong contractions.
frequent, and ineffective at progressing
labor.
Risk Factors for Uterine Dysfunction:
●​ Secondary (Hypotonic) Uterine
●​ Labor Disorder: Abnormalities in the
Dysfunction:
progression or function of labor.
Uterine contractions are weak or infrequent,
●​ Maternal Pushing Efforts: Ineffective or
leading to insufficient cervical dilation and
inadequate maternal pushing during labor.
fetal descent.
●​ Chorioamnionitis: Inflammation and
●​ Protraction Disorder
infection of the placenta, amniotic fluid,
fetus, and membranes.

Nipple Stimulation and Contraction Labor Disorder:

Stress Test: (NSCST) ●​ Latent Phase Prolongation:
○​ The first stage of labor is prolonged,
usually taking longer than normal.
Nipple stimulation can induce uterine contractions,
●​ Active Phase Disorder:
and it is sometimes used to evaluate how the
○​ Active Phase Protraction:
uterus responds to stress, especially in assessing
■​ Cervical dilation less than 1
the potential for labor.
cm per hour.
○​ Active Phase Arrest:
POPP (Persistent Occiput Posterior Position):
■​ No cervical dilation for 2
●​ 2% to 10% of singleton term cephalic
hours or more.
fetuses present with the frontal part of the
Second Stage Dysfunction:
skull (including the forehead and top of the
●​ Delayed Fetal Descent:
head) as the first part to descend into the
○​ The baby’s descent through the birth
birth canal.
canal is delayed, which can lead to
Hypotonic Labor:
prolonged second-stage labor.
●​ A type of abnormal labor pattern
Dysfunction in the First Stage of Labor:
characterized by weak and infrequent
1.​ Prolonged Latent Phase:
contractions.
○​ Lasts longer than 20 hours.
●​ Hypotonic Uterine Contractions:
○​ The cervix fails to dilate effectively to
○​ The number of contractions is
allow labor to progress.
infrequent.
pg.6 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
○​ Intervention: If it does not progress, Pressure is Elevated
a Cesarean section (C-section) or Intake and Output
amniotomy (artificial rupture of Tetanic Contractions
membranes) may be required, along Oxygen decrease in fetus
with oxytocin to stimulate Cardiac arrhythmia
contractions. Irregularity in FHR
2.​ Protracted Active Phase: Nausea and Vomiting
○​ Typically associated with fetal
malposition, such as occiput Fetal Pelvic Disproportion (FPD)
posterior or breech position, leading ●​ An abnormality in the passageway, where
to a slower rate of dilation and the fetal head is too large to pass through
progression. the maternal pelvis, leading to difficulty
during labor.
Second Arrest of Dilation:
●​ During labor, when the cervix stops dilating
after having already begun to dilate. This
pause in progression can last for a period of
time.

Failure of Descent:
●​ Labor lasts for many hours without any
progress in the descent of the baby through
the birth canal.

Amniotomy (Artificial Rupture of Membranes -

AROM or SROM):
●​ A procedure in which the amniotic sac is
intentionally ruptured to speed up labor.
●​ This is often done to accelerate the
progress of labor when there are concerns
about prolonged labor or to increase the
effectiveness of contractions.
Arrest of Descent:
●​ The baby’s head does not move down the
birth canal during labor, which can result in
a delay in the progress of labor.

Maternal Pushing Efforts:

●​ The mother is unable to resist the urge to
push during uterine contractions, which can
sometimes contribute to labor complications
if not managed properly.

Chorioamnionitis:
●​ Inflammation and infection of the placenta,
amniotic fluid, fetus, and membranes.
●​ Some suggest that this maternal
intrapartum infection contributes to
abnormal uterine activity and can negatively
affect labor progression.
Watch for Hypotension:
●​ Antidiuretic Side Effects:
○​ Monitor blood pressure and fluid
balance during labor to avoid
complications such as hypotension.

Side Effects of Pitocin (Oxytocin): Shoulder Dystocia:

pg.7 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Inability to deliver the infant's shoulder by
the usual maneuvers following the delivery
of the infant's head. SHOULDER DYSTOCIA MANAGEMENT
●​ Shoulder dystocia occurs when the fetal
biacromial diameter (the width of the
shoulders) cannot pass through the pelvic
inlet (obstetric conjugate).
●​ After the head is delivered, there is an
arrest or trapping of the shoulder behind the
symphysis pubis or the sacral promontory,
preventing further delivery.
McRoberts Maneuver:
●​ Hyperflexing the mother’s thighs tightly to
Steps in Treating Shoulder Dystocia:
her abdomen to straighten the sacrum and
Two Main Signs:
widen the pelvis.
●​ Prolonged Second Stage of Labor
●​ Recoil of the Head on the Perineum
○​ Turtle’s Sign:
●​ The fetal head suddenly retracts
back against the mother's perineum
after it has been delivered.
●​ Visible Sign: The baby’s cheeks
bulge out.
Comparison of Delivery Time:
Suprapubic Pressure:
●​ The mean head-to-body delivery time in a
●​ Applying external pressure above the pubic
normal birth is 24 seconds, compared with
bone to push the fetal shoulder downward
79 seconds in those with shoulder dystocia.
and dislodge it.

Maternal and Neonatal Consequences:

The risks are greater for the fetus than for the
mother.

Main Risks:
●​ Perineal Tears
●​ Postpartum Hemorrhage (Uterine Atony):
Persistent relaxation of the uterus after Corkscrew (woods) Maneuver
delivery. ●​ Rotating the fetal shoulders 180° to relieve
impaction.
Neonatal Problems:
●​ Neuromusculoskeletal Injury
●​ Asphyxia
●​ Umbilical Cord Injury
●​ Brachial Plexus Injury
●​ Clavicular Fracture
●​ Neonatal Acidosis at Delivery

Management:
●​ Avoid Aggressive Manipulation Rubin’s Maneuver
●​ Gentle Attempt at Traction Assisted by ●​ Pushing the posterior portion of the anterior
maternal expulsive efforts. shoulder toward the fetal chest to reduce
●​ Perform a Large Episiotomy To widen the the diameter.
vaginal canal, facilitating easier delivery.
●​ Episiotomy may be erected to complete
needed maneuvers

pg.8 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Rectovaginal Fistula:
●​ An abnormal connection between the
rectum and the vagina, which allows gas,
stool, or feces to pass through the vagina.

Vesicovaginal Fistula:
●​ An abnormal connection between the
bladder and the vagina, causing urine to
Gaskin Maneuver: leak from the bladder into the vagina.
●​ Placing the mother in an all-fours position to
facilitate shoulder release. Vaginal Perinatal Complications:

1.​ Rectal Sepsis:

○​ Infection or sepsis occurring in the
rectal area, potentially spreading to
other organs.
2.​ Caput Succedaneum:
○​ Swelling of the soft tissue on the
infant’s head caused by pressure
during delivery, typically resolves
Cleidotomy: within a few days.
●​ Surgically cutting the fetal clavicle to reduce 3.​ Mechanical Trauma:
shoulder dystocia. ○​ Injury to the fetus during delivery
due to forceps, vacuum extraction,
or other instruments.
4.​ Facial Paralysis:
○​ Loss or abnormal facial muscle
movement in a fetus due to
congenital anomalies or birth trauma
affecting the cranial nerve.
Zavanelli Maneuver:
Umbilical Cord Prolapse:
●​ The fetal head is pushed back into the
pelvis for a cesarean delivery in cases of
●​ Occurs when the umbilical cord precedes
severe obstruction.
the fetal presenting part, such as the head,
in the birth canal.
●​ A cord loop can be palpated in the vaginal
canal before the presenting part.
●​ This is more common in women with
ruptured membranes.

Symphysiotomy:
●​ Surgically cutting the symphysis pubis to
widen the pelvis.

Types of Umbilical Cord Prolapse:

●​ Overt Prolapse:
Decapitation: ○​ The cord is visible or palpable ahead
●​ Severing the fetal head in cases of severe of the presenting part.
obstruction, typically for nonviable fetuses. ●​ Occult Prolapse:
○​ The cord is not visible or palpable,
and it is hidden behind the
presenting part.
pg.9 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Funic Prolapse: Amniotic Fluid Embolism
○​ between the presenting part and ●​ Solid particles in amniotic fluid enter through
fetal membrane an open maternal uterine blood sinus, often
through defects in the membranes.
●​ TOTALES
○​ Risk that is complete or fully present. Thrombus
●​ PARCIALES ●​ Coagulation
○​ Condition that is present but not
complete. Respiratory Symptoms
●​ MARGINALES 1.​ Restlessness
○​ Condition that is on the edge or 2.​ Chest Pain
borderline, often carrying a lesser 3.​ Cyanosis
degree of severity but requires Circulatory Collapse
monitoring. 1.​ Hypotension
2.​ Tachycardia
●​ CEREBRAL PALSY 3.​ Cardiac Arrest
○​ Non-progressive brain damage that
affects movement, muscle tone, and Note:
posture. ●​ Urine output: 30-50mL/hr
●​ Decelerations ECMO
○​ Abrupt decreases in fetal heart rate ●​ Extracorporeal Membrane Oxygenation
that vary in shape, duration, and (ECMO):​
timing, concerning uterine Used in severe cardiac and respiratory
contractions. failure to provide temporary heart and lung
Positions for Cord Compression support.
Because of gravity, the presenting part of the fetus
will move away from the compressed cord. Classification of Uterine Rupture
1.​ Trendelenburg
2.​ Sims ●​ Uterine rupture is frequently a catastrophic
3.​ Knee-chest event.
Types of Uterine Rupture:
Important management steps: 1.​ Primary Rupture
○​ Previously intact or unscarred
1.​ Recognize uterus.
2.​ Relieve pressure ○​ Can occur due to degeneration,
3.​ Remove the pressure. injury, or anomalies in the
myometrium.
Subdural Hematoma Types of Cesarean Sections (CS):
●​ Intracranial hemorrhage 1.​ Lower Segment Cesarean Section
●​ Blood collects between the dura mater and (LSCS)
the brain due to tearing of bridging veins. ○​ Vertical incision.
2.​ Lower Segment Transverse Cesarean
Section (LTCS)
○​ Horizontal incision.
3.​ Classical Cesarean Section (CS)
○​ Vertical incision.
○​ Prone to adhesions between the
uterus and abdomen.
Metroplasty
●​ A surgical procedure to correct congenital or
Partograph acquired uterine anomalies.
●​ A tool used to monitor labor progress and Peritonitis
identify complications early. ●​ Inflammation of the visceral and parietal
peritoneum.

pg.10 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
○​ Prior PROM or preterm delivery
○​ Prior cervical surgery
○​ Vaginal bleeding
RUPTURE OF MEMBRANES
○​ Placental pathology
○​ Male fetus
1.​ ROM (Rupture of Membranes): Maternal Effects:
a.​ This term generally refers to the 1.​ Infection
breaking of the amniotic sac, 2.​ Prolapse of the umbilical cord
resulting in the leakage of amniotic 3.​ Premature birth
fluid. Fetal Effects:
2.​ PROM (Premature Rupture of Membranes): ●​ Prematurity
a.​ This occurs when the membranes ●​ Respiratory complications
rupture before labor begins, typically Normal Bacterial Flora of the Vagina
after 37 weeks of gestation but The vagina maintains a healthy microbial balance,
before the onset of labor. primarily consisting of beneficial bacteria that help
3.​ PPROM (Preterm Premature Rupture of prevent infections.
Membranes): 1.​ Döderlein Bacilli
a.​ This refers to membrane rupture that ○​ A general term for lactobacilli
occurs before 37 weeks of gestation present in the vagina.
and before labor starts. This ○​ Plays a crucial role in maintaining
condition can pose risks to both vaginal pH and preventing
mother and baby. infections.
4.​ SROM (Spontaneous Rupture of 2.​ Lactobacillus acidophilus
Membranes): ○​ A type of lactobacillus that produces
a.​ This indicates that the membranes lactic acid, keeping the vaginal
have ruptured naturally during labor, environment acidic (pH 3.8–4.5).
usually after the onset of ○​ Inhibits the growth of harmful
contractions. bacteria and pathogens.
5.​ AROM (Artificial Rupture of Membranes): Manifestations of PROM
a.​ This is a procedure (also known as 1.​ Contractions may or may not be present.
amniotomy) performed by healthcare 2.​ Pelvic pressure.
providers to deliberately rupture the 3.​ Menstrual-like cramps.
membranes to induce or augment 4.​ Watery vaginal discharge.
labor. 5.​ Lower back pain.
6.​ Maternal fever.
Rupture of the Bag of Wate Assessment for PROM
●​ Premature Rupture of Membranes (PROM) 1.​ Time of rupture of membranes.
occurs when the bag of water ruptures 2.​ Fetal heart rate and maternal vital signs.
before the onset of labor. 3.​ Check perineum for prolapsed cord.
●​ When the membranes break, the amniotic 4.​ Characteristics of leaking amniotic fluid
fluid surrounding the fetus starts to leak or (odor and color).
gush out of the vagina.
Note:
Risk Factors: ●​ Color of amniotic fluid is more important as
1.​ Modifiable Factors: it indicates meconium staining.
○​ Cervicovaginitis ●​ Maternal vital signs should be checked
○​ Incompetent cervix (dilates without for:
apparent reason) 1.​ Manifestations of maternal fever.
○​ Cigarette smoking 2.​ Tachycardia.
○​ Chronic villus sampling or 3.​ Signs of developing fetal distress.
amniocentesis
○​ Coitus
○​ Mineral and vitamin deficiency
○​ Cervical examinations

2.​ Non-Modifiable Factors:

pg.11 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Preterm Labor Management of Preterm Labor

●​ Occurs before the end of week 37 of 1.​ Corticosteroids

gestation and is accompanied by cervical ○​ Administered to enhance fetal lung
changes (dilation and effacement). maturity (e.g., betamethasone or
●​ Cervical dilation of at least 2 cm confirms dexamethasone).
progression. 2.​ Magnesium Sulfate
●​ Braxton Hicks contractions are painless ○​ Acts as a tocolytic by blocking
contractions that do not cause cervical calcium influx into uterine muscles,
changes. reducing contractions.
3.​ Anticonvulsants (Centrally Active)
IUGR (Intrauterine Growth Restriction) ○​ Used to prevent seizures in
●​ It refers to a condition in which a fetus does eclampsia and may have a tocolytic
not grow to its expected size and weight effect.
during pregnancy. IUGR can result from 4.​ Bed Rest
various factors, including maternal health ○​ Helps reduce uterine activity and
issues, placental problems, or fetal prevent premature labor.
abnormalities. 5.​ Hydration and Sedation
○​ Hydration: Reduces the release of
Transient Tachypnea of the Newborn (TTN) oxytocin, which can trigger
●​ A temporary respiratory condition in contractions.
newborns caused by delayed clearance of ○​ Sedation: Can help relax uterine
fetal lung fluid after birth. muscles and delay labor.
●​ Common in term and late preterm infants, 6.​ Amniocentesis
especially those born via cesarean section ○​ Performed to detect infection and
without labor. assess fetal lung maturity.
●​ Resolves within 24 to 72 hours with ○​ Measures the
supportive care (oxygen, CPAP if needed). Lecithin-Sphingomyelin (L/S)
Ratio:
Fetal Fibronectin (fFN) Test ■​ ≥2:1 indicates lung
●​ Fetal fibronectin is a protein found in the maturity.
fetal membranes and is an indicator of ■​ <2:1 suggests risk of
preterm labor risk. respiratory distress
●​ Measured using an enzyme-linked syndrome (RDS).
immunosorbent assay (ELISA). 7.​ Magnesium Sulfate (MgSO₄)
●​ A value exceeding 50 mg/mL (nanograms ●​ Mechanism: Blocks calcium influx into
per milliliter) is considered positive, uterine muscles, acting as a tocolytic to
suggesting a higher risk of preterm labor prevent contractions.
within 7–14 days. 8. Calcium Channel Antagonists (e.g.,
Nifedipine)
Fetal Movement Monitoring (Cardiff Method) ●​ Inhibits calcium entry into smooth muscle
●​ Cardiff Count-to-Ten Method: The mother cells, reducing uterine contractions.
counts fetal movements until 10 ●​ Used as a first-line tocolytic for delaying
movements are felt within a 12-hour preterm labor.
period. 9. Beta-Adrenergic Receptor Agonists (e.g.,
●​ Decreased fetal movement may indicate Terbutaline, Ritodrine)
fetal distress and requires further ●​ Mechanism: Stimulates beta-2 receptors,
evaluation. relaxing uterine smooth muscle.
●​ Side Effects: Tachycardia, hypotension,
hyperglycemia.
10. Glucocorticoid Therapy (e.g.,
Betamethasone, Dexamethasone)
●​ Enhances fetal lung maturity by increasing
surfactant production.

pg.12 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
11. Antimicrobial Therapy
●​ Treating infections that may contribute to 1. Early Postpartum Hemorrhage
preterm labor (e.g., bacterial vaginosis, ●​ Occurs within the first 24 hours after
chorioamnionitis, UTI). delivery.
12. Prostaglandin Inhibitors (NSAIDs, e.g., ●​ Most commonly caused by uterine atony
Indomethacin) (failure of the uterus to contract properly).
●​ Inhibits prostaglandin production, which is
responsible for uterine contractions. 2. Late Postpartum Hemorrhage
●​ Used in short-term tocolysis (<48 hours) ●​ Occurs after 24 hours but within 6 weeks
for delaying labor. postpartum.
●​ Usually caused by retained placental
fragments or infection (endometritis).
Obstetrical Hemorrhage

The Four T’s of Postpartum Hemorrhage

Antepartum Hemorrhage 1.​ Tone (Uterine Atony)
○​ Most common cause of PPH
(Before Delivery)
(accounts for ~70% of cases).
○​ The uterus fails to contract properly,
●​ First Trimester Causes: leading to excessive bleeding.
○​ Abortion (spontaneous or induced) ○​ Management: Uterine massage,
○​ Ectopic Pregnancy (implantation oxytocin, uterotonics (misoprostol,
outside the uterus, often in the carboprost, methylergonovine).
fallopian tube) 2.​ Trauma (Genital Tract Trauma)
●​ Second Trimester Causes: ○​ Lacerations, precipitous delivery
○​ Incompetent Cervix (premature (very rapid labor and birth), uterine
cervical dilation leading to rupture, or uterine inversion.
pregnancy loss) ○​ Bleeding persists despite a firm
○​ Hydatidiform Mole (H Mole) uterus.
(abnormal growth of trophoblastic ○​ Management: Surgical repair of
tissue, leading to bleeding) lacerations, uterine packing, or
●​ Third Trimester Causes: balloon tamponade.
○​ Abruption Placenta (premature 3.​ Tissue (Retained Products of Conception
separation of the placenta, causing - RPOC)
painful bleeding) ○​ Placental fragments or
○​ Placenta Previa (placenta covering membranes left inside the uterus
the cervix, causing painless prevent proper contraction.
bleeding) ○​ Management: Manual removal,
dilation & curettage (D&C),
Postpartum Hemorrhage (After Delivery) uterotonics.
4.​ Thrombin (Coagulation Abnormalities)
○​ Clotting disorders that prevent
●​ Defined as the loss of ≥500 mL of blood normal blood clot formation.
after a normal spontaneous vaginal delivery ○​ Causes: Disseminated Intravascular
(NSVD) or ≥1000 mL after a cesarean Coagulation (DIC), HELLP
section. syndrome, severe preeclampsia,
●​ The greatest danger is within the first 24 amniotic fluid embolism.
hours after birth.
Signs of Severe Blood Loss Classification of Postpartum Hemorrhage (PPH)
●​ Oliguria: Decreased urine output. 1.​ Early Postpartum Hemorrhage – Occurs
●​ Anuria: Absence of urine production. within the first 24 hours after delivery.
2.​ Late Postpartum Hemorrhage – Occurs
HYPOVOLEMIC SHOCK after 24 hours and up to 6 weeks
●​ A life-threatening condition caused by postpartum.
severe blood or fluid loss, leading to
inadequate oxygen supply to vital organs.
Postpartum Hemorrhage (PPH)

pg.13 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Types of Shock in Obstetrics
Major Interventions for Postpartum
(Altered Hemodynamic Condition)
Hemorrhage
1.​ Maintaining Good Uterine Tone
1.​ Hemorrhagic Shock (Hypovolemic ○​ Uterine massage, oxytocin
Shock) administration, uterotonics
○​ Caused by severe blood loss, (misoprostol, methylergonovine).
leading to inadequate oxygen 2.​ Preventing Bladder Distension
delivery to tissues. ○​ Encourage urination or catheterize if
○​ Examples: Uterine atony, placental necessary to prevent uterine
abruption, trauma. displacement.
2.​ Cardiogenic Shock
○​ Caused by heart failure leading to Postpartum Assessment: BUBBLE-HEAP
inadequate circulation. Acronym
○​ Examples: Peripartum
cardiomyopathy, amniotic fluid
embolism affecting the heart.
Postpartum care and assessment:
3.​ Septic Shock
○​ Caused by severe infection,
leading to systemic inflammation ●​ B – Breasts (engorgement, nipple pain,
and organ dysfunction. breastfeeding support).
○​ Examples: Endometritis, ●​ U – Uterus (fundal height, tone, involution).
chorioamnionitis. ●​ B – Bladder (urinary retention, distension).
4.​ Hypersensitivity Shock (Anaphylactic ●​ B – Bowels (constipation, hemorrhoids).
Shock) ●​ L – Lochia (amount, color, odor of vaginal
○​ Caused by severe allergic discharge).
reactions, leading to vasodilation ●​ E – Episiotomy/Perineum (healing, pain,
and respiratory distress. infection signs).
○​ Examples: Anaphylaxis due to ●​ S - Skin
antibiotics, oxytocin, or anesthesia. ●​ H – Homan’s Sign (DVT assessment, leg
pain/swelling).
●​ E – Emotional Status (postpartum blues,
depression screening).
●​ A – Attachment (bonding with the baby,
maternal-infant interaction).
●​ P – Pain (general postpartum pain
assessment).

Postpartum care and assessment

1.​ Bimanual Compression of the Uterus

Placental Separation Mechanisms ○​ The uterus is compressed between
1.​ Duncan Mechanism the fist (internally) and the
○​ The placenta separates from the external hand to stop bleeding.
uterus irregularly with the
maternal side (rough surface)
delivered first.
○​ Associated with more bleeding.
2.​ Schultze Mechanism
○​ The placenta separates from the ○​
center outward, with the fetal side 2.​ Insert Intra-Foley Catheter (IFC)
(shiny, smooth surface) delivered ○​ Ensures an empty bladder, which
first. helps the uterus contract effectively.
○​ Less bleeding, as blood remains
trapped until the placenta is
expelled.

pg.14 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

3.​ Manage Hypovolemic Shock

○​ IV fluids, blood transfusion,
Instruments for D&C
oxygen therapy, and monitoring
vitals.
4.​ Tranexamic Acid (TXA) 1.​ Speculum – Used to open and visualize the
○​ Antifibrinolytic drug that helps cervix.
reduce postpartum hemorrhage by
stabilizing blood clots.
○​ Given within 3 hours of PPH onset
to improve survival.

a.​
2.​ Heavyweight Retractors – To hold back
vaginal walls.

a.​
3.​ Anterior Retractors – Used to pull and
Balloon Tamponade hold the cervix forward.
●​ A procedure where a balloon catheter
(e.g., Bakri balloon) is inserted into the
uterus and inflated to apply direct
a.​
pressure on bleeding vessels.
4.​ Posterior Retractors – Used to hold back
●​ Used in severe postpartum hemorrhage
the posterior vaginal wall.
(PPH) when medications fail.
●​ Reduces the need for surgery (e.g.,
hysterectomy).

D&C (Dilation and Curettage) a.​

5.​ Tenaculum – A clamp used to grasp the
●​ A surgical procedure where the cervix is cervix for stabilization.
dilated, and the uterine lining is scraped
using a curette.
●​ Uses: a.​
○​ Treats abnormal uterine bleeding 6.​ Hysterometer – Measures the depth and
(AUB). size of the uterine cavity.
○​ Removes retained products of
conception (RPOC) after a.​
miscarriage. 7.​ Curette (Dull & Sharp) – Used to scrape
○​ Diagnoses endometrial conditions the uterine lining.
(fractional curettage for diagnostic
purposes).

a.​
Abnormal Uterine Bleeding (AUB)
8.​ Kidney Basin – Holds collected tissue or
fluids.
●​ Menorrhagia – Excessive menstrual
bleeding (heavy or prolonged).

Punch Biopsy
●​ A procedure to obtain a small tissue a.​
sample from the cervix or endometrium for
histopathological examination.
pg.15 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

Injuries to the Birth Canal Perineal Laceration Assessment

1.​ Check if it is perineal or cervical.
1.​ Vulvovaginal Laceration 2.​ Ffresh vaginal bleeding.
○​ Tears involving the vulva and 3.​ S/S of shock.
vaginal walls, often caused by 4.​ Level of consciousness (LOC).
precipitous labor, instrumental
delivery, or macrosomia (large
Types of Perineal Lacerations
baby).
2.​ Cervical Laceration ***hindi po complete to T^T***
○​ Occurs when the cervix is torn
during labor, often due to rapid 1.​ First-Degree Laceration – Involves the
delivery, inadequate dilation, or vaginal mucosa, perineal skin.
instrumental assistance. 2.​ Second-Degree Laceration – Extends to
○​ Bleeding despite a firmly the fascia and muscles surrounding the
contracted uterus suggests vagina.
cervical or genital tract laceration. 3.​ Third-Degree Laceration – Involves the
vaginal mucosa, perineal skin, fascia, and
external anal sphincter.
Types of Episiotomy 4.​ Fourth-Degree Laceration – Extends
through the vaginal mucosa, perineal skin,
fascia, muscles surrounding the vagina, and
1.​ Median Episiotomy (Midline) external anal sphincter (hindi ko nanote
○​ Incision extends straight down from yung kasunod T_T)
the vaginal opening toward the anus.
2.​ Mediolateral Episiotomy Cervical Injury
○​ Incision is angled diagonally away ●​ Cervical tears may extend to involve the
from the vaginal opening. lower uterine segment and uterine artery.
●​ Usually found on the sides of the cervix,
Perineal Lacerations (Tears in the Perineum) near the branches of the uterine artery.
●​ Injuries to the lower portion of the vagina, ●​ This results in arterial bleeding, which is
often extending to the rectal sphincter or brighter red compared to the venous blood
vaginal depth. lost in uterine atony.
●​ Can be unilateral or bilateral.
●​ May involve the anterior vaginal wall near Avulsion
the urethra. ●​ A type of injury where skin or tissue is
forcibly detached.
●​ It appears like a cauliflower, with the skin
scraped or torn away.
R-E-E-D-A mnemonic

Fundal Pressure
1.​ R – Redness ●​ The application of manual pressure on the
2.​ E – Ecchymosis (Bruising around the uterine fundus to assist in the delivery of the
wound site) fetus during labor.
3.​ E – Episiotomy (Condition of the incision or
laceration) Interventions
4.​ D – Discharge 1.​ Monitor vital signs.
5.​ A – Approximate wound edges 2.​ Administer IV fluids and prepare for possible
(Aponeurosis of the Sutured Vaginal Wall) blood transfusion.
●​ The aponeurosis refers to the 3.​ Notify the physician.
fibrous tissue layer that supports 4.​ Assist the physician in the procedure.
the vaginal wall, which may be a.​ Colporrhaphy
involved in suturing perineal or b.​ Suturing of Perineal Laceration
vaginal lacerations after childbirth.

pg.16 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

Colporrhaphy
●​ Surgical repair of the vaginal wall, often
done for pelvic organ prolapse.
Suturing of Perineal Laceration
●​ Closure of perineal tears sustained during
childbirth to promote healing and prevent
infection.

Puerperal Hematoma
●​ Collection of blood in the subcutaneous
layer of the perineum due to ruptured blood
vessels, causing swelling and pain.
●​ The overlying skin remains intact, with no
visible trauma. Procidentia Uteri (Uterine Prolapse)
●​ Blood accumulates underneath, creating a ●​ Severe form of uterine prolapse where the
painful swelling in the affected area. entire uterus protrudes outside the vaginal
●​ Most common after rapid spontaneous birth opening.
or in women with perineal varicosities. ●​ Occurs due to weakened pelvic floor
muscles and ligaments.
Vulvar Hematoma
Forms in the vulvar region, often due to trauma or Prolapsed Uteri (Uterine Prolapse)
ruptured varicose veins. ●​ Descent of the uterus into the vaginal canal
due to weakened pelvic support.
Vaginal Hematoma
Develops inside the vaginal wall, often following Halothane Gas Anesthesia
forceps delivery or episiotomy. ●​ A volatile inhalational anesthetic used for
inducing and maintaining general
anesthesia.
●​ Known for its muscle-relaxing properties but
Uterine Inversion
can cause hypotension and hepatotoxicity.

●​ Outward descent of the uterus after the third

stage of labor.
○​ Why third stage?
■​ This is the placental stage,
where separation and
expulsion of the placenta
occur.
●​ The uterine fundus passes through the
cervix, turning the uterus inside out.

Risk Factors
1.​ Fundal placental implantation
2.​ Uterine atony
3.​ Excessive cord traction before placental Uterine Inversion
separation.
4.​ Abnormally adherent placenta (e.g., Accreta
Syndrome (Morbidity Adherent Placenta)) Postpartum Hemorrhage (PPH)
Excessive bleeding after childbirth, often due to
uterine atony, retained placenta, trauma, or
coagulation disorders.

Subinvolution
●​ Arrest of involution, meaning the uterus
remains enlarged and soft beyond the
normal postpartum period.
pg.17 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

ABORTION
●​ At 4– or 6- weeks postpartum, if the uterus
is still enlarged and soft, subinvolution is
Abortion refers to the interruption, spontaneous or
suspected. induced, of a pregnancy before fetal viability
●​ Most important vital sign: Temperature, to defined as less than 20 weeks of gestation or fetal
assess for infection. weight less than 500 gms.

Venous Return Medical Abortion – Induced using drugs.

●​ The flow of blood back to the heart through
Surgical Abortion – Performed using dilation and
the veins. curettage (D&C) or suction.
●​ Can be affected by pregnancy due to
increased blood volume and pressure on Pathogenesis
pelvic veins.
●​ Necrosis of adjacent tissue stimulates
uterine contractions, leading to expulsion.
Puerperal Infection
●​ More than 80% of spontaneous abortions
●​ Infection of the reproductive tract within 28 occur within the first 12 weeks of gestation.
days postpartum or after abortion.
●​ Includes endometritis, wound infections, Blighted Ovum
urinary tract infections (UTIs), and mastitis.
A fertilized egg implants in the uterus but does not
develop into an embryo.
Septicemia
●​ Presence of bacteria or toxins in the Risk Factors for Abortion
bloodstream, leading to systemic infection
and possibly septic shock. Fetal Factors

Thrombophlebitis 1.​ Chromosomal Abnormalities – Most

common cause.
●​ Inflammation of a vein due to a blood clot
a.​ Euploid Abortion – Half of all
(thrombus). abortions involve a fetus with normal
●​ Can occur in the deep veins of the legs or chromosomes.
pelvis postpartum (DVT or pelvic b.​ Trisomy – Usually due to
thrombophlebitis). nondisjunction, more common with
advanced maternal age.

Maternal Factors
TRIMESTER
●​ Infections
●​ Medical Disorders
Trimester-Related Pregnancy Complications ●​ Cancer and Radiation Exposure
●​ Surgical Procedures
First Trimester ●​ Trauma
●​ Nutrition
●​ Abortion (Spontaneous or Induced)
●​ Weight
●​ Ectopic Pregnancy
●​ Social and Behavioral Factors
Second Trimester
Environmental Factors
●​ Hydatidiform Mole (H. Mole) / Gestational
Exposure to Dichlorodiphenyltrichloroethane (DDT)
Trophoblastic Disease (GTD)
●​ Cervical Insufficiency (Incompetent Cervix) Paternal Factors
Third Trimester Advanced paternal age increases risk, particularly
after 25 years, rising in 5-year intervals.
●​ Abruptio Placenta
●​ Placenta Previa Specific Causes of Early Abortion
●​ Placental Disorders
A. Chromosomal Abnormalities

Most common cause of early spontaneous

abortion.

pg.18 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Discomfort in uterus since it will try to
contract

B. Cervical Insufficiency
2.​ INCOMPLETE ABORTION
●​ Cervix dilates prematurely without
contractions Partial expulsion of products of conception;
everything is gone but placenta remains.​
C. Antiphospholipid Antibody Syndrome (APAS)
/ Hughes Syndrome
3.​ COMPLETE ABORTION
●​ Autoimmune disorder increasing the risk of
blood clots, leading to pregnancy loss. ●​ Everything came out. (even placenta ^)
●​ An autoimmune disorder that increases ●​ Complete expulsion of entire pregnancy
the risk of blood clots (thrombosis), ●​ Cannot be diagnosed unless:
recurrent pregnancy loss, and pregnancy ○​ true products of conception are seen
complications. The immune system grossly
mistakenly produces antibodies against ○​ unless sonography
phospholipids, which are essential for
normal blood clotting, leading to excessive
clot formation in blood vessels.
4.​ MISSED ABORTION
Key Antibodies in APS:
●​ Dead products of conception that have been
●​ Lupus Anticoagulant retained for days or weeks in the uterus with
●​ Anticardiolipin a closed cervical OS
●​ Anti-β2 Glycoprotein 1 ●​ Transversal sonography is a primary tool
●​ 5 to 6 weeks gestation, a 1- to 2- mm
Related Conditions: embryadjacent to the yolk sac can be seen

●​ Thrombosis – Formation of a blood clot.

●​ Thrombocytopenia – Low platelet count. 1.​ FHT in first trimester rises from 110 to 130
●​ Mesenteric Phlebosis – Blood clot in bpm at 6wks gestation to 160-170 bpm at
mesenteric veins. 8wks
2.​ Subchorionic hematoma, that is, blood
Management of APAS: collected between chorion and uterine wall
●​ Heparin
●​ Warfarin
●​ Aspirin 5.​ INEVITABLE ABORTION

To Prevent Miscarriage:
●​ Gush of Vaginal Fluid (ni-highlight ni doc)
●​ A pregnancy loss that cannot be prevented,
●​ Enoxaparin
characterized by rupture of membranes
●​ IV Immunoglobulin
(ROM), cervical dilation, and vaginal
●​ Corticosteroids
bleeding, leading to the unavoidable
Classification of Abortion expulsion of the fetus before 20 weeks of
gestation.
1. Induced Abortion

Medical or surgical termination before fetal viability 6.​ IMMINENT ABORTION

●​ Therapeutic Abortion – Done for maternal

or fetal health reasons. ●​ a pregnancy that is in the process of being
●​ Elective/Voluntary Abortion – Performed lost, where abortion is unavoidable due to
by choice. severe bleeding, strong uterine
●​ Illegal/Criminal Abortion – Performed in contractions, and cervical dilation.
unsafe conditions

2. Spontaneous Abortion 7.​ SEPTIC ABORTION

●​ Threatened Abortion – Vaginal bleeding

with a closed cervix in the first 20 weeks of ●​ Spontaneous abortion, organisms may
pregnancy with live embryo fetus. invade, myometrial tissues, and extend to
cause parametritis, peritonitis, septicemia
pg.19 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

●​
8.​ HABITUAL/RECURRENT ABORTION
Diagnostic Procedures
Three or more consecutive abortion
●​ Culdocentesis – Checks for free fluid in the
●​ Primary RPL – multiple losses in a woman pelvic cavity.
that never delivered a liveborn ●​ Laparoscopy – Direct visualization of the
●​ Secondary RPL – multiple losses in a fallopian tubes and pelvis.
patient with a prior live birth.
Surgical Treatment

●​ Laparotomy – Open abdominal surgery.

●​ Salpingostomy – Opening the fallopian
9.​ MID-TRIMESTER ABORTION
tube.
●​ Salpingotomy – Incision into the fallopian
Pregnancy loss occurring between 12 to 20 weeks tube.
of gestation. ●​ Salpingectomy – Removal of the fallopian
tube.
Diagnostic Tests

●​ hCG Testing – Declining levels indicate

fetal demise.
INSTRUMENTS
●​ Transvaginal Ultrasound (TVS) – Detects
pregnancy in early stages.
●​ Pelvic Ultrasound – Assesses overall
uterine condition.
1.​ Vaginal Speculum – to hold open the
Subchorionic Hematoma – Blood accumulation vaginal walls for examination or procedures,
between the chorion and uterine wall. allowing access to the cervix.

MANAGEMENT OF ABORTION
a.​
2.​ Tenaculum – instrument with hooked ends
used to grasp and hold the cervix or uterus
●​ Bed Rest
during procedures.
●​ Acetaminophen – Pain management.
●​ Progesterone Supplements
○​ Duphaston (Dydrogesterone)
○​ Hergest (Gestone)
●​ Blood Loss Management

a.​
3.​ Ovum Forceps / Sponge Forceps – Long,
scissor-like instruments used for grasping
ECTOPIC PREGNANCY
and removing tissue, such as retained
products of conception from the uterus
Implantation of the fertilized egg outside the uterine
cavity.

Heterotopic Pregnancy (a.k.a Combined Ectopic

Pregnancy) – Simultaneous intrauterine and
ectopic pregnancy. a.​
4.​ Metal Bowl with OS (Operating Scissors)
Ultrasound Findings – A stainless-steel bowl used to collect
tissue or fluids during procedures, often
●​ “Wiggling Sign” accompanied by operating scissors for
●​ “Curtain Sign” cutting.
●​ “Cystic Ring of Fire” – Doppler sign of
ectopic pregnancy.

pg.20 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

a.​
5.​ Syringe with Spinal Needle – A long, thin
needle attached to a syringe, used for
aspiration procedures such as
culdocentesis (removal of fluid from the
pelvic cavity).

3.​ Transabdominal Cerclage – Performed if

vaginal cerclage is not possible.

Additional Terms

Spalding Sign – Overlapping skull bones,

a.​ indicating fetal demise.

Halo Sign – Hypoechoic area around the

gestational sac.
Cervical Insufficiency & Cerclage
Intraamniotic Hyperosmotic Solutions – Used to
Cervical cerclage is a surgical procedure to prevent induce second-trimester abortion.
pregnancy loss due to an incompetent cervix.

Types of Cerclage:
GESTATIONAL TROPHOBLASTIC DISEASE
(notes ni Jeanne, ty po! ^^)

●​ Group of tumors
●​ AB trophoblast proliferation
●​ Trophoblast produce HCG
●​ Hydatidiform Mole
○​ Grapelike
●​ Bleeding, Abortion, Ectopic
●​ Placenta Previa

Gestational Trophoblastic Disease (GTD) is

characterized by the abnormal development of the
placenta, leading to excessive trophoblastic
proliferation. This results in grape-like clusters of
edematous, immature placental tissue with varying
1.​ McDonald Technique – Purse-string degrees of malignancy.
sutures placed around the cervix.
●​ Presence of villi within the trophoblastic
tissue.
●​ Non-molar trophoblastic malignancy may
develop in some cases.
●​ Excessively edematous and immature
placental tissue, leading to abnormal
growth patterns.
●​ Benign Complete Hydatidiform Mole – A
non-cancerous form where placental tissue
grows abnormally without fetal
2.​ Shirodkar-Barter Technique – More development.
permanent, with sutures placed higher on ●​ Malignant Invasive Mole – A more
the cervix. aggressive type that penetrates the uterine
wall, potentially leading to complications
such as hemorrhage or metastasis.

pg.21 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Pregnancy-Induced Hypertension (PIH) or
Preeclampsia
Types of Gestational Trophoblastic
●​ Uterine Hemorrhage – Can range from
Disease (GTD)
moderate to severe, leading to iron
deficiency anemia.

1.​ Invasive Mole Management

a.​ malignant form of hydatidiform mole
that invades the uterine ●​ Preeclampsia
myometrium. ●​ D&C
2.​ Choriocarcinoma ●​ Prophylactic course of methotrexate the
a.​ A highly malignant and aggressive drug of choice for choriocarcinoma
trophoblastic tumor. ●​ Urine test for a year
b.​ Develops from a molar pregnancy,
normal pregnancy, or miscarriage Actinomycin D - prophylaxis
3.​ Placental Site Trophoblastic Tumor
(PSTT) Follow up care
a.​ A rare, slow-growing tumor
originating from the intermediate ●​ Baseline CXR
trophoblast. ●​ Pelvic Exam
b.​ Unlike choriocarcinoma, PSTT does ●​ Initial B-hCG (48 hr)
not produce high levels of hCG ●​ 25 wks (mawawala na ang hCG)
4.​ Epithelioid Trophoblastic Tumor (ETT) ●​ No pregnancy for a year
a.​ A rare variant of PSTT with a more ●​ Advised contraception
aggressive course.
b.​ Arises from chorionic-type Gestational Trophoblastic Neoplasia (GTN)
intermediate trophoblasts.
A group of malignant conditions arising from
Molar Pregnancy (Hydatidiform Mole - H Mole) trophoblastic tissue after a molar pregnancy,
miscarriage, or normal pregnancy. These tumors
an abnormal form of pregnancy resulting from have a strong tendency to metastasize and require
improper fertilization, leading to the formation of aggressive treatment.
grape-like vesicles instead of a normal placenta. It
is classified into: Findings:

●​ Complete Hydatidiform Mole ●​ Propensity to metastasize

○​ no fetal tissue present ●​ GTN - Irregular bleeding associated with
○​ Fertilization of an empty ovum by a uterine subinvolution
sperm, leading to 46XX or 46XY ●​ bleeding may continue
chromosomes entirely from the
father (androgenesis). Invasive Mole
●​ Partial Hydatidiform Mole
○​ Some fetal tissue present but ●​ Invade myometrium / uterine vessels
non-viable. present in extrauterine sites (metastatic H.
○​ Fertilization of a normal ovum by mole)
two sperm (69XXX, 69XXY, 69XYY). ●​ Fertilization of egg goes wrong
●​ Invasive Mole ●​ Abnormal cells cluster of water filled sacs
○​ A malignant form of hydatidiform inside
mole that deeply invades the uterine ●​ CAD- chorioadeomadestruens
myometrium. ●​ excessive tissue invasion by trophoblastic
and whole villi
Clinical Manifestations of Molar Pregnancy ●​ Every small amount of molar tissue can
(Hydatidiform Mole) grow and cause problems

●​ Amenorrhea CHORIOCARCINOMA
●​ Fundal height is larger than expected for
gestational age due to excessive
trophoblastic growth Fast-growing malignant tumor that arises from
●​ Vaginal Bleeding ​ trophoblastic cells, typically developing in the
●​ Grape-like Vesicular Discharge (Sago-like uterus, ovaries, or other reproductive organs. It is a
vesicles) highly aggressive cancer with a strong tendency to
●​ High urine, serum hCG Levels metastasize to distant sites such as the lungs, liver,
●​ No Fetal Heart Tone and brain.
●​ Severe Nausea and Vomiting (Hyperemesis
Gravidarum)

pg.22 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
CLASSIFICATION PLACENTA PREVIA
Causes & Risk Factors
1. Complete (Total) Placenta Previa
●​ More common after a molar pregnancy
(hydatidiform mole). ●​ The placenta fully covers the cervical os.
●​ Highest risk of severe bleeding during labor.
Chorio- = Chorion, the outer membrane covering ●​ Requires C-section delivery.
the developing fetus.
2. Partial Placenta Previa
Carcinoma = Cancer that arises from epithelial
cells. ●​ The placenta partially covers the cervical
os.
●​ cancer in the ovaries ●​ Vaginal delivery is usually not possible due
●​ more common after a molar pregnancy to the risk of hemorrhage.
●​ happen after a
○​ Full-term pregnancy 3. Marginal Placenta Previa
○​ Miscarriage
○​ Ectopic pregnancy ●​ The placental edge reaches the internal
cervical os but does not cover it.
●​ May allow for vaginal delivery, but bleeding
THIRD TRIMESTER BLEEDING &
risk is high.
ANTEPARTUM HEMORRHAGE
4. Low-Lying Placenta
Antepartum Hemorrhage (APH) refers to vaginal
bleeding occurring after 20 weeks of gestation but ●​ The placenta is implanted in the lower
before delivery. It can result from maternal, uterine segment but does not reach the
placental, or fetal causes, requiring urgent cervical os.
evaluation and management. ●​ May migrate upward as pregnancy
progresses, reducing the risk of
1. Placental Causes complications.

●​ Placenta Previa – Abnormal implantation of

PATHOPHYSIOLOGY
the placenta over or near the cervix, leading
to painless vaginal bleeding.
●​ Placental Abruption (Abruptio Placentae) – ●​ Abnormal placental implantation and
Premature separation of the placenta from insufficient vascularization of the decidua.
the uterine wall, causing painful vaginal ●​ Disruption of placental attachment in the
bleeding. late second or third trimester.
●​ Vasa Previa – Rupture of fetal blood vessels ●​ Thrombin release from the bleeding site
in the membranes covering the cervix, triggers clot formation and further uterine
leading to fetal distress and severe fetal contractions.
bleeding. ●​ Uterine contractions worsen placental
separation, leading to more bleeding and
2. Maternal Causes fetal compromise.

●​ Uterine Rupture – A life-threatening Risk Factors

condition where the uterus tears, often due
to previous C-section scars, leading to ●​ Multiple gestation (twins or more)
severe maternal and fetal distress. ●​ Maternal age > 35–40 years
●​ Preterm labor history
●​ Previous uterine surgery (e.g., C-section,
PLACENTA PREVIA
myomectomy)
●​ Smoking
a condition where the placenta is abnormally ●​ Short intervals between pregnancies
implanted in the lower uterine segment, covering or ●​ Recurrent miscarriages
partially covering the cervix, which can lead to ●​ Uterine fibroids (leiomyoma)
complications during pregnancy and delivery. ●​ Infertility treatments
●​ Obesity or excessive pregnancy weight
Uteroplacental Insufficiency
Clinical Features of Placenta Previa
Uteroplacental insufficiency refers to inadequate
blood flow and oxygen delivery to the fetus due to ●​ Painless vaginal bleeding (bright red) –
placental dysfunction, which can result in fetal The most characteristic sign of placenta
growth restriction (FGR), hypoxia, or distress. previa.

pg.23 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Fetal malpresentation – The baby may Clinical Features of Abruptio Placentae:
present in breech or transverse lie due to
the placenta obstructing the lower uterine ●​ Sudden onset of painful, dark red vaginal
segment. bleeding
●​ High-floating and unengaged fetal head – ●​ Uterine tenderness and rigidity
The baby does not descend into the pelvis. ●​ Tetanic contractions (Hypertonic uterus) –
Prolonged, sustained uterine contractions
Diagnosis: ●​ Fetal distress or fetal demise (depending on
severity)
●​ Ultrasonography (USG) – The gold
standard for diagnosing placenta previa. Types of Placental Abruption Based on Extent
●​ Double Setup Vaginal Examination of Separation:
(DSVE) – Performed in a controlled
environment (operating room) when 1.​ Partial Separation – Some placental
placenta previa is suspected, to determine detachment, with varying degrees of fetal
the feasibility of vaginal delivery. distress.
2.​ Total Separation – Complete detachment,
Ready for surgery – If severe bleeding occurs often leading to fetal death.
during examination.
Types of Placental Abruption Based on Mode of
Ready for vaginal delivery – If placenta previa is Bleeding:
minimal and bleeding is controlled.
1.​ External (Revealed) – Blood escapes
through the cervix, leading to visible vaginal
bleeding.
2.​ Concealed – Blood is trapped between the
Three prominent factors affecting
placenta and the uterus, making the
management
hemorrhage less obvious but more
dangerous.
●​ Fetal age and maturity – Determines if
preterm delivery is necessary. Etiology (Causes/Risk Factors) of Abruptio
●​ Labor status – Determines whether Placenta:
immediate delivery is required.
●​ Severity of bleeding – Guides treatment ●​ Increased maternal age and parity –
decisions, including possible C-section. Higher risk with advanced maternal age and
multiple pregnancies.
Medications for Fetal Lung Maturity: ●​ Premature rupture of membranes
(PROM) – Early rupture of membranes
●​ Dexamethasone weakens placental attachment.
●​ Betamethasone ●​ Cigarette smoking – Causes vascular
damage, increasing the risk of placental
(Enhances surfactant production to accelerate lung separation.
maturity in preterm fetuses.) ●​ Trauma – Abdominal trauma from accidents
or domestic violence can trigger abruption.
ABRUPTIO PLACENTA ●​ Short umbilical cord – Puts tension on the
placenta, leading to detachment.
●​ Polyhydramnios – Excess amniotic fluid
the premature separation of the placenta from its increases uterine pressure, predisposing to
site of implantation before the delivery of the fetus. abruption.
This condition is a sudden obstetric emergency that ●​ HELLP Syndrome – A severe form of
can lead to maternal hemorrhage and fetal distress. preeclampsia, leading to vascular damage
and placental detachment.
●​ Often described as the “rendering asunder
of the placenta”, indicating a sudden and Additional Concepts:
unexpected placental detachment.
●​ The initial event is usually the rupture of a Tetanic Contraction
decidual spiral artery, leading to the
formation of a retroplacental hematoma, ●​ A sustained, strong uterine contraction that
which expands and further detaches the does not relax, often seen in abruptio
placenta. placentae and associated with fetal distress.
●​ If the blood is retained between the
detached placenta and the uterus, it results Uteroplacental Apoplexy (Couvelaire Uterus)
in a concealed hemorrhage.
●​ A life-threatening complication of severe
placental abruption, where blood infiltrates
the uterine muscle (myometrium), leading to
pg.24 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
uterine atony and massive postpartum
hemorrhage.
Placenta Accreta Spectrum (PAS)
ABRUPTIO PLACENTA
a spectrum of placental attachment disorders
where the placenta abnormally adheres to or
premature separation of the placenta from the invades the uterine wall. It is a serious obstetric
uterine wall before the birth of the baby, leading to condition that can lead to severe hemorrhage
bleeding, fetal distress, and potential maternal during delivery.
shock.
Etiopathogenesis
Pathophysiology:
●​ The primary issue is the failure of the
●​ Normally, the placenta remains attached to placenta to detach normally after delivery.
the uterine wall until after birth. ●​ Microscopically, placental villi attach directly
●​ In abruptio placenta, blood vessels rupture to smooth muscle fibers instead of the
between the placenta and the uterus, normal decidual cells.
causing a hematoma (collection of blood). ●​ The severity depends on how deeply the
●​ This disrupts the oxygen and nutrient supply placenta invades the uterine wall.
to the fetus, potentially leading to hypoxia
(low oxygen levels) and stillbirth. NITABUCH LAYER

Types of Abruptio Placenta: The Nitabuch layer is a thin fibrinoid layer that
normally separates the placental villi from the
1.​ Concealed Hemorrhage – Blood collects uterine myometrium. In Placenta Accreta Spectrum
behind the placenta, with no visible vaginal (PAS), this layer is absent or defective, leading to
bleeding. abnormal placental invasion.
2.​ Revealed Hemorrhage – Blood escapes
through the cervix, causing vaginal
PLACENTA ACCRETA, INCRETA, &
PERCRETA
Management:

Mild Cases (Stable Mother and Fetus): Placenta accreta spectrum refers to abnormal
placental attachment to the uterine wall due to
●​ IV fluid therapy to maintain blood pressure. defective decidua basalis (the maternal part of the
●​ Tocolytics (e.g., nifedipine, terbutaline) – placenta).
Used in selected cases to delay labor if
preterm.
●​ Steroid administration (betamethasone,
dexamethasone) – Enhances fetal lung
maturity in preterm pregnancy.

Severe Cases (Heavy Bleeding, Fetal Distress,

or Maternal Instability):

●​ Emergency cesarean section (C-section) to

prevent fetal asphyxia. Types:
●​ Blood transfusion for hemorrhagic shock.
●​ Monitor for complications like renal failure 1.​ Placenta Accreta – The placenta is
and hypovolemic shock. abnormally attached to the uterus but does
not invade the muscle.
ABRUPTIO PREVIA 2.​ Placenta Increta – The placenta invades
the uterine muscle (myometrium).
placental detachment placenta in lower 3.​ Placenta Percreta – The placenta
uterine segment penetrates through the uterus and may
placenta covering invade nearby organs like the bladder.
internal OS
Normal Placenta & Placental
no placenta within 5cm palpable placental
of internal OS cotyledons at the Anomalies
cervical os
Normal Placenta

●​ Weight: ~470 g
●​ Shape: Round to oval
●​ Diameter: ~22 cm
pg.25 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Thickness: ~2.5 cm
●​ Components:
○​ Placental disc 4. Battledore Placenta
○​ Extra-placental membranes
○​ Three-vessel umbilical cord ●​ The umbilical cord is attached at the margin
(edge) of the placenta instead of the center.
Cotyledons
5. Velamentous Cord Insertion
The maternal surface of the placenta is the basal
plate, which is divided into lobes called ●​ Umbilical cord inserts into the fetal
cotyledons. These sections contain fetal blood membranes rather than the placenta itself.
vessels and facilitate nutrient exchange. ●​ Blood vessels are exposed and travel
through the membranes before reaching the
placenta.

6. Placenta Membranacea
PLACENTAL ANOMALIES
●​ Rare condition where chorionic villi cover
General Placental Anomalies the entire fetal membranes, either partially
or completely.
●​ Normal placenta weight: ~500 g
●​ Diameter: 15–20 cm 7. Ring-Shaped Placenta
●​ ThicknesS: 1.5–3 cm
●​ Weight Ratio: The placenta is approximately ●​ Annular (ring-shaped) variant of placenta
1/6 the weight of the fetus. membranacea.
●​ May have a complete ring of placental
Anomalies: tissue or a horseshoe-shaped variant due to
partial atrophy.
1.​ Placenta Succenturiata
2.​ Bilobed Placenta 8. Placenta Fenestrata
3.​ Circumvallate Placenta
4.​ Battledore Placenta ●​ rare condition where the central portion of
5.​ Velamentous Cord Insertion the discoid placenta is missing.
6.​ Placenta Membranacea
7.​ Ring-Shaped Placenta 9. Extrachorial Placentation
8.​ Placenta Fenestrata
9.​ Extrachorial Placentation ●​ Occurs when the chorionic plate is smaller
10.​Placental Tumor - Chorioangioma than the basal plate, causing the placental
edges to fold back.

Two Types:
1. Placenta Succenturiata
●​ Circummarginate Placenta – Mild form
●​ Presence of one or more accessory lobes with smooth edges.
connected to the main placenta via blood ●​ Circumvallate Placenta – More severe
vessels. form with raised edges and fibrin deposition.
●​ The placenta may appear torn after delivery,
risking retained placental tissue and 10. Placental Tumor – Chorioangioma
postpartum hemorrhage.
●​ A benign vascular tumor arising from the
2. Bilobed Placenta blood vessels and stroma of the chorionic
villi.
●​ Two roughly equal-sized lobes separated by
a membrane.
●​ The umbilical cord may be inserted into
either lobe, be velamentous, or lie between
the lobes.

3. Circumvallate Placenta

●​ Extrachorial, annular-shaped placenta with

raised edges composed of chorion, amnion,
degenerated decidua, and fibrin deposits.
●​ The chorionic plate is smaller than the basal
plate, leading to hematoma retention at the
placental margin.
pg.26 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Placental Maternal Fetal Illustration
Variation Implicatio Implicatio
n n
(new topic)
Succenturiat Postpartal None as long
e Placenta hemorrhage as all parts of
- one or more from retained the placenta HYPERTENSION
accessory lobe remain
lobes of fetal attached until
vill develop on after birth of
the placenta the fetus
Hypertension (HTN) in pregnancy is defined as
systolic blood pressure (BP) ≥140 mmHg or
diastolic BP ≥90 mmHg on two separate occasions
Circumvallate Increase Intrauterine at least 4 hours apart after 20 weeks of gestation in
Placenta incidence of growth
- a double fold late abortion, retardation, a previously normotensive woman.
of chorion and antepartal prematurity,
amnion form a hemorrhage fetal death
ring around and preterm
the umbilical labor
cord on the Types of Hypertension in Pregnancy
fetal side of
the placenta
1.​ Chronic Hypertension (CHTN)
Battledore Increase Prematurity, a.​ HTN before pregnancy or diagnosed
Placenta incidence of non before 20 weeks gestation.
- umbilical preterm labor reassuring
cord is and bleeding fetal status b.​ May persist beyond 12 weeks
inserted at or postpartum.
near the
placental
c.​ Increased risk of preeclampsia and
margin fetal growth restriction (FGR/IUGR).
2.​ Gestational Hypertension
Velamentous Hemorrhage if Non a.​ HTN developing after 20 weeks of
insertion of one of the reassuring
the cord vessels is torn fetal status, gestation without proteinuria or
- vessels of hemorrhage end-organ damage.
the umbilical
cord divide
b.​ Temporary condition that usually
some distance resolves postpartum.
from the c.​ Can progress to preeclampsia.
placental
membrane 3.​ Preeclampsia
a.​ HTN after 20 weeks gestation with
proteinuria (≥300 mg/24 hrs) OR
end-organ dysfunction.
Anomalies of the Umbilical Cord b.​ Severe Preeclampsia includes:
i.​ BP ≥160/110 mmHg
●​ Two-Vessel Cord ii.​ Thrombocytopenia
●​ A normal umbilical cord contains one vein (<100,000/µL)
and two arteries. iii.​ Elevated liver enzymes
●​ In a two-vessel cord, one umbilical artery is (HELLP Syndrome)
absent, which may indicate congenital iv.​ Pulmonary edema
anomalies. v.​ Visual or neurological
○​ Associated with: symptoms
■​ Congenital heart defects 4.​ Eclampsia
■​ Renal (kidney) anomalies a.​ Preeclampsia + Seizures (not
■​ Other mesodermal defects caused by any other neurological
due to developmental condition).
disruption. b.​ Medical emergency requiring
immediatr management.
5.​ Preeclampsia Superimposed on Chronic
Hypertension
a.​ Chronic HTN + new-onset
proteinuria OR worsening BP &
organ dysfunction after 20 weeks.
b.​ Increased risk of HELLP syndrome,
placental abruption, and fetal
complications.
6.​ Eclampsia Superimposed on Chronic
Hypertension
a.​ Chronic HTN + preeclampsia +
seizures.
b.​ Severe form of hypertensive crisis in
pregnancy.

pg.27 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
c.​ Higher maternal and fetal mortality
risk due to stroke, multi-organ
failure, and placental abruption. HELLP Syndrome
7.​ Late Transient Hypertension
a.​ Mild hypertension appearing late in ●​ A severe form of preeclampsia involving:
pregnancy, typically in the third ●​ Hemolysis (destruction of red blood cells)
trimester, without proteinuria or ●​ Elevated Liver enzymes (indicating liver
organ dysfunction. dysfunction)
b.​ Usually resolves after delivery. ●​ Low Platelets (thrombocytopenia)
c.​ Lower risk of complications
compared to other hypertensive
disorders.
Pulmonary Embolism (PE)

●​ A life-threatening condition where a blood

PROTEINURIA
clot (embolus) blocks a pulmonary artery.
HTN EDEMA
●​ Pregnant women are at higher risk due to
Gestational Positive Negative Negative hypercoagulability in pregnancy.
HTN
Cryoprecipitate
Gestational Negative Positive Negative
Edema ●​ A blood product derived from fresh frozen
Gestational
plasma (FFP).
Negative Negative Positive
Proteinuria ●​ Rich in clotting factors, including:
○​ Fibrinogen
○​ Factor VIII (Anti-hemophilic factor)
Preeclampsia Classification ○​ Von Willebrand factor
●​ Early-Onset Preeclampsia
○​ Occurs < 34 weeks gestation.
●​ Late-Onset Preeclampsia
○​ Occurs > 34 weeks gestation.
●​ Preterm-Onset Preeclampsia
○​ Occurs < 37 weeks gestation.
●​ Term-Onset Preeclampsia
○​ Occurs at or > 37 weeks gestation.

Liver Enzymes ​

●​ AST (Aspartate Aminotransferase) /

SGOT (Serum Glutamic Oxaloacetic
Transaminase)
○​ Found in liver, heart, skeletal
muscle, and kidneys.
○​ Elevated in liver damage (e.g.,
HELLP syndrome, hepatitis),
myocardial infarction, and muscle
injury.
●​ ALT (Alanine Aminotransferase) / SGPT
(Serum Glutamic Pyruvic Transaminase)
○​ More specific to liver function than
AST.
○​ Elevated in liver disorders such as
hepatitis, fatty liver disease, and liver
failure.
○​

Stretching of the Glisson’s Capsule of the Liver

●​ The Glisson’s capsule is a fibrous covering

of the liver.
●​ Severe preeclampsia or HELLP syndrome
can cause liver swelling and hematoma,
leading to capsular stretching.

pg.28 l HENSON, C.B.

JULIA | MATERNAL AND CHILD NURSING (at risk) NOTES
JULIA | MATERNAL AND CHILD NURSING (at risk) NOTES
JULIA | MATERNAL AND CHILD NURSING (at risk) NOTES
JULIA | MATERNAL AND CHILD NURSING (at risk) NOTES
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)

Nursing Interventions for SGA/UGR:

1. Promote Optimal Growth and Development
2. Monitor and Address Nutritional Status
3. Prevent Infection:
4. Provide Developmental Stimulation

PRIORITY NURSING ACTION

• Regular reassessment, documentation, and
ongoing evaluation of the baby's response to
interventions are crucial to modity the care plan as
needed and ensure optimal outcomes.
• Collaboration with the healthcare team,
adherence to ethical and legal standards, and
maintaining confidentiality are vital aspects of
nursing interventions for SGA babies.

FETAL MACROSOMIA
●​ Macrosomia is defined as birthweights that
exceed certain percentiles for a given
population)
●​ Macrosomia is a condition where a fetus is
larger than average.
●​ It's usually delined by the baby's birth
weight, rather than their gestational age.
●​ Macrosomia is frequently defined based on
mathematical distributions of birthweight

Diabetes Mellitus
●​ chronic disease caused by improper
Causes and Risk Factors of Impaired Fetal metabolic interaction on carbo., fats,
Growth proteins, and insulin.
●​ an inherited metabolic diseasé cause by a
●​ Maternal
disturbance in normal production of insulin
●​ Medical and obstetric conditions:
●​ an endocrine disorder in which the
●​ Preeclampsia
pancreas cannot produce adequate insulin
●​ Placental abruption
to regulate body glucose levels.
●​ Chronic hypertension
●​ the condition may be a concurrent disease
●​ Chronic kidney disease
in pregnancy or have its first onset during
●​ Pregestional diabetes mellitus
gestation
●​ Systemic lupus erythematosus
●​ Antiphospholipid syndrome
●​ Cyanotic heart disease Significance of diabetes in pregnancy
●​ Chronic pulmonary disease ●​ interaction of estrogen, progesterone, HCS/
●​ Severe chronic anemia HPL and cortisol raise maternal resistance
●​ Sickle cell disease to insulin
●​ If the pancreas cannot respond by
MANIFESTATIONS AND DIAGNOSIS producing additional nsuln, excess glucose
moves across placenta to letus vhere fetal
●​ Diagnosis is based on discrepancies
insulin metabolizes it, and acts as growti.
between actual and expected sonographic
hormone, promoting macrosomia.
biometric measurements for a given
gestational age:
●​ Suspect IUGR if fundic height is 3 cm less TYPES OF DIABETES
than expected ●​ In nonpregnant individuals, the type of
●​ Sonographic EFt is Oth percentile for diabetes is based on its presumed
gestational age on a standardized pathogenesis and its manifestations.
population growth curve ○​ Absolute insulin deficiency, which
●​ Ultrasound with Doppler studies is most generally is autoimmune in etiology,
effective in differentiating between characterizes type 1 diabetes.
pathologic ○​ In contrast, insulin resistance,
●​ IUGR and a constitutionally small fetus. relative insulin deficiency, or
elevated glucose production
characterizes type 2 diabetes.

pg.29 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
○​ Both types are generally preceded Etiological Classification of Diabetes Mellitus
by a period of abnormal glucose
homeostasis often referred to as Type 1:
prediabetes. ●​ B Cell destruction, usually absolute insulin
○​ Pancreatic cell destruction can deficiency
begin at any age, but type 1 ●​ immune-mediated
diabetes is clinically apparent ●​ Idiopathic
most often before age 30.
●​ Type 2 diabetes usually develops with Type 2-
advancing age but is increasingly identified ●​ Ranges from predominant insulin resistance
in younger obese adolescents. to predominantly an insulin secretory defect
○​ Etiological overlap in diabetes with insulin resistance
subtypes is well established and has Other types
led to the proposal of a single ●​ Genetic mutations of B cell function MODY
classification system centered on 1-6, others
B-cell function along with the ●​ Genetic defects in insulin action
concept of individualized treatment ●​ Genetic syndromes: Down, Klinefelter,
strategies. Turner, others
○​ Other forms of diabetes include ●​ Diseases of the exocrine pancreas
maturity-onset diabetes of the young pancreatitis cystic fibrosis
(MODY). ●​ Endocrinopathies: Cushing syndrome,
○​ The more common MODY type is in pheochromocytoma, others
obese adolescents. ●​ Drug or chemical induced:
○​ The less common form is an glucocorticosteroids, thiazides, B -
autosomal dominant condition and adrenergic agonists, others Congenital
characterized by mild diabetes infections rubella, cytomegalovirus,
diagnosed in adolescence or young coxsackievirus
adulthood
Gestational diabetes (GDM)
Classification During Pregnancy MODY = maturity onset diabetes of the young.
●​ Diabetes is the most common medical
complication of pregnancy. PREGESTATIONAL DIABETES
●​ Women can be separated into those ●​ Pregestational Pregnancy is type 1 or type 2
diagnosed with diabetes before pregnancy - diabetes that existed before pregnancy
pregestational or overt diabetes, and those ●​ Women with high plasma glucose levels,
diagnosed during pregnancy-gestational glucosuria, and ketoacidosis present no
diabetes. diagnostic challenge.
●​ The proportion of pregnancies complicated ●​ Women with a random plasma glucose level
by diabetes more than doubled after which > 200 mg/dL plus case seas and symptoms
rates have leveled such as polydipsia, polyuria, and
●​ Prevalence is highest among Asians, unexplained weight loss, those with a
non-Hispanic, blacks, Americans. fasting glucose level >125 mg/DL, or those
Mexican-Americans, Puerto with a first-trimester glycosylated
Rican-Americans, and Native hemoglobin (HbAlc) level of 26.5 percent
are considered to have to have overt
Pre gestational DM diabetes first detected in pregnancy
●​ DM diagnosed in a woman even before ●​ Women with only minimal metabolic
pregnancy derangement may be more dificult to
identify.
Gestational DM (GDM)
●​ Diagnosed in the 2nd and 3rd trimester of Fetal Effects
pregnancy that is not clearly overt DM “The ●​ Spontaneous Abortion
word gestational" implies that diabetes is ●​ Preterm delivery
induced by pregnancy ●​ Malformations
●​ Most important perinatal correlate is ●​ Unexplained Fetal Demise
excessive fetal growth (primary effect
●​ Hydramnios
attributed to GDM is macrosomia)
●​ Neonatal Effects
●​ Respiratory Distress Syndrome
Overt DM
●​ Hypoglycemia and Hypocalcemia
●​ Pregnant woman who meets the standard
●​ Hypertiliubineria and Polycythemia
non-pregnant criteria for diagnosis of DM
●​ Long-term Cognitive Development
●​ Inheritance
●​ Altered Fetal Growth
pg.30 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
with its onset or first recognition during
Altered Fetal Growth pregnancy.
●​ Diminished fetal growth may result from ●​ The term gestational diabetes aims to
congenital malformations or from substrate communicate the need for enhanced
deprivation due to advanced maternal surveillance during pregnancy and to
vascular disease stimulate further testing postpartum.
●​ Fetal overgrowth is more typical of ●​ The most important perinatal correlate is
pregestational diabetes. excessive fetal growth, which may result in
●​ Maternal hyperglycemia prompts fetal both maternal and fetal birth trauma.
hyperinsulinemia, and this in tum stimulates
excessive somatic growth. Risk factors for Gestational DM
●​ Except for the brain, most fetal organs are ●​ Obesity
affected by the macrosomia that ●​ >25 years old
characterizes the fetus of diabetic women ●​ Family Hx of DM
●​ * This is attributed to the hyperplasia of fetal ●​ HX Of LGA (>10 Ibs)
B-islet cells that is induced by chronic ●​ Hx of unexplained fetal or perinatal loss
matemal hyperglycemia. ●​ Hx of congenital anomalies in previous
●​ Low glucose concentrations- defined as < pregnancy
45 mg/dI-are particularly common in ●​ History of polycystic ovary syndrome
newboms of women with unstable glucose ●​ Family history of diabetes (one close
concentrations during labor. relative or two
●​ Hypocalcemia is defined as a total serum ●​ Member of population with a high risk for
calcium concentration <8 mg/dl in term DM
newbors.
●​ Early-onset hypocalemia is one of the
Diagnosis - Clinical manifestations
potential metabolic derangements in
●​ Family History
neonates of diabetic mothers.
●​ Oral Glucose Tolerance Test
●​ Theories include altered
magnesium-calcium economy, asphyxia, ●​ HbA1C
and preterm birth ●​ FBS
●​ Urinalysis
Maternal Effects
●​ Preeclampsia ORAL Glucose Tolerance Test
●​ Diatetic nephropathy ●​ The recommended two-step approach
●​ Diabetic retinopathy begins with either universal or risk-based
selective screening using a 50-g, I-hour oral
●​ Diabetic neuropathy
glucose challenge test.
●​ Diatetic ketoacidosis
●​ This 50- screening test is followed by a
●​ Infections diagnostic 100g, 3-hour oral glucose
tolerance test (OT if screening results meet
Diabetes ketoacidosis (DA) or exceed a predetermined plasma glucose
●​ results from an insulin deficiency combined concentration.
with an excess in counter-regulatory ●​ Done 24 - 28 weeks AOG
hormones such as glucagon. ●​ 50 grams of glucose will be ingested by
●​ Gluconeogenesis is the metabolic process the patient = 1 hour > 140 mg/dl
where the body synthesizes glucose from
non-carbohydrate sources like glycerol, ●​ For the 50-g screening test, the plasma
lactate, and certain amino acids, primarily in glucose level is measured 1 hour last meal.
the liver and kidneys, to maintain blood after a 50-g oral glucose load without regard
glucose levels, especially during fasting or to the time of day or time
low carbohydrate intake. ●​ Result > 140 do a 3 hours OTT after 3 days
●​ Metabolic changes associated with (100gm oral glucose)
pregnancy
Procedure for the 75g OGTT:
Gestational diabetes (GDM) is any degree of ●​ Ast the patient to have at least 3 days of
glucose intolerance with the onset of recognition unrestricted carbohydrate intake (>150 g
occuring during pregnancy. carbohydrate daily)
●​ Gestational implies that diabetes is induced ●​ Perform the test in the morning (79 am)
by pregnancy- ostensibly because of alter an 8-14 hour overnight fast (water is
exaggerated physiological changes in allowed).
glucose metabolism. ●​ Smoking or physical activity are not
●​ Gestational diabetes is defined as permitted during the test.
carbohydrate intolerance of variable seventy ●​ Extract the intial lasting blood glucose (FBS)
sample.
pg.31 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Give the patient a standard 75 glucose ●​ Constitutional factors (e.g., pre-gestational
solution in 250-300 mL of water, to be BMI)
ingested within 5 minutes. ●​ Metabolic disorders (e.g., diabetes mellitus)
●​ Extract blood samples after 1 hour
postprandial glucose (PPG) and 2 hours Risk Factors
PPG of the glucose load
●​ The lest should not be done during acute ●​ Genetics (e.g., syndromes, race, and
illness ethnicity)
●​ Maternal diabetes (GDM)
Treatment ●​ Obesity & excessive weight gain in
pregnancy (strongest predictors)
1.​ Early pregnancy- less insulin
●​ History of macrosomic babies
2.​ Later pregnancy - increase amount bec. of
●​ Fetal sex (male > female)
metabolic rate increase
●​ Maternal age ≥ 35 years old
3.​ Insulin - short acting (regular) combined
●​ Excessive amniotic fluid (≥ 60th percentile)
with intermediate 2/3 of the amount AM 30
●​ Grand multiparity (G5 and above)
mins before breakfast
●​ Prolonged pregnancy
a.​ 1/3 PM 30 mins AC 30 mins before
dinner
Diagnosis
b.​ Intermediate : Short acting 2:1 (AM)
c.​ Intermediate: Short 1:1 (PM) ●​ Fundal height measurement (top of uterus
4.​ Insulin Therapy Optimal for women with to pubic bone).
GDM or type 2 DM who are not able to ●​ Ultrasound (Abdominal Circumference [AC]
maintain normoglycemia with a > 35 cm → most reliable UTZ parameter).
carbohydrate-restricted diet is insulin ●​ Amniotic fluid level check.
●​ Non-stress test (measures fetal heart rate in
Oral Hypoglycemic Agents response to movement).
- For pregnant patients with overt diabetes already ●​ Biophysical profile (combines non-stress
on metformin prior to pregnancy, consider test with ultrasound).
continuing metformin as long as glucose control is
maintained it not, may shift to insulin therapy) Complications

Fetal:

FETAL MACROSOMIA ●​ Shoulder dystocia

●​ Clavicular fracture & nerve damage
●​ Brachial plexus injury
Fetal macrosomia refers to a newborn who is
significantly larger than average. It is usually Maternal:
defined by birth weight rather than gestational age.
●​ Postpartum hemorrhage (PPH)
●​ Large for Gestational Age (LGA): Weight, ●​ Birth canal trauma & lacerations
length, or head circumference (HC) above
the 90th percentile for age of gestation Neonatal:
(AOG).
●​ Macrosomia: Birth weight (BW) ●​ Hypoglycemia & respiratory problems
○​ ≥ 4,000 g regardless of AOG or ●​ Increased risk of early-onset Type 2
○​ > 90th percentile for AOG (corrected Diabetes
for neonatal sex and ethnicity). ●​ Higher risk for Cesarean Section (CS)
●​ Grades of Macrosomia:
○​ Grade I: 4,000 - 4,499 g
○​ Grade II: 4,500 - 4,999 g
○​ Grade III: ≥ 5,000 g POSTTERM PREGNANCY
Pathogenesis
A pregnancy that extends beyond 42 weeks (≥ 294
●​ 5-10% associated with maternal diabetes. days from LMP).
●​ Excess release of insulin-like growth
factors, growth hormone, and insulin → Terminology
abnormal cell enlargement → increased
fetal size. ●​ Postterm / prolonged / postdate
pregnancy: Pregnancy beyond 42 weeks.
Causes ●​ Postmature infant: A newborn showing
signs of placental insufficiency.
●​ Genetic factors
●​ Environmental factors
pg.32 l HENSON, C.B.
ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ Postmaturity Syndrome: Clinical fetal
PSEUDOCYESIS (false pregnancy)
syndrome with features indicating a
pathologically prolonged pregnancy.
A rare condition where a person believes they are
Newborn Features pregnant, despite negative tests and no fetus
present.
●​ Wrinkled, patchy, peeling skin
●​ Long nails Causes
●​ Long, thin body suggesting wasting
●​ Open-eyed, unusually alert, “old & worried” ●​ Psychological factors (e.g., intense desire
appearance for pregnancy).
●​ Hormonal imbalances (e.g., increased
Etiology prolactin).

●​ Inaccurate dating of pregnancy Symptoms (mimic real pregnancy)

●​ Low estrogen levels (e.g., anencephaly,
fetal adrenal/pituitary hypoplasia) ●​ Breast tenderness & enlargement
●​ Genetic predisposition ●​ Abdominal distension
●​ Irregular ovulation ●​ Missed periods
●​ Weight gain
Pathophysiology ●​ Morning sickness & cravings
●​ False labor contractions
●​ Oligohydramnios (↓ amniotic fluid volume)
→ cord compression → fetal distress.
●​ Placental Dysfunction → reduced
nutrient/oxygen delivery → postmaturity HYPEREMESIS GRAVIDARUM
syndrome.
●​ Dysmaturity Syndrome → growth-restricted
infant despite prolonged gestation. Severe, persistent nausea & vomiting in pregnancy
that leads to weight loss, dehydration, and
Complications electrolyte imbalances.

Maternal: Pathophysiology

●​ Macrosomia (70-80%) ●​ Unknown exact cause; likely multifactorial.

●​ Oligohydramnios ●​ High or rapidly rising pregnancy hormones
●​ Preeclampsia (hCG, estrogen, progesterone,
●​ Cesarean Section (due to fetal jeopardy or thyroid-stimulating hormone).
dystocia) ●​ Other hormonal links: Ghrelin, leptin,
●​ Postpartum hemorrhage nesfatin-1, peptide hormones.
●​ Perineal lacerations & assisted delivery
(forceps/vacuum) Assessment

Perinatal: ●​ Severe nausea & vomiting (worse in the

morning).
●​ Postmaturity syndrome (20-30%) ●​ Weight loss & dehydration.
●​ Stillbirth ●​ Fluid & electrolyte imbalances.
●​ Meconium aspiration syndrome ●​ Ketonuria (sign of starvation ketosis).
●​ Birth injuries (e.g., fractures, nerve damage) ●​ Signs of metabolic disturbances (alkalosis,
●​ Hypoxic-ischemic encephalopathy hypokalemia, hypochloremia).
●​ Infections & NICU admission
●​ Childhood obesity & neonatal seizures Complications

Management ●​ Severe dehydration → acute kidney injury

●​ Mallory-Weiss tears (esophageal rupture
●​ Start fetal surveillance at 41 weeks. due to retching)
●​ Induce labor at 41 weeks if no spontaneous ●​ Gastroesophageal rupture (Boerhaave
labor. syndrome)
●​ After 42 weeks: Induction of labor or ●​ Pneumothorax & pneumomediastinum
elective CS. ●​ Wernicke encephalopathy (thiamine
deficiency → confusion, ataxia, eye
movement issues)

Management

pg.33 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
●​ First-line antiemetics: ●​ First prenatal visit: Anti-D antibody titer test
○​ Doxylamine + Pyridoxine (Diclegis) ●​ If titer < 1:8 (minimal), repeat at 28 weeks.
○​ Ondansetron (Zofran) (more ●​ If titer ≥ 1:16, fetus is monitored via Doppler
effective but used cautiously) velocity of the middle cerebral artery for
●​ Severe cases: IV fluids, electrolyte anemia.
replacement, total parenteral nutrition
(TPN). Prevention:

Nursing Interventions ●​ Rhogam (RhIG) injection at 28 weeks

gestation and within 72 hours postpartum (if
●​ Monitor VS, I&O, weight, and labs. baby is Rh-positive).
●​ Check for dehydration & ketonuria. ●​ Also given after miscarriage, abortion,
●​ Encourage small, frequent meals (low-fat, ectopic pregnancy, or invasive procedures.
high-carb). ●​ Not needed if the father is Rh-negative.
●​ Encourage fluid intake between meals.
●​ Monitor fetal well-being (heart rate, growth, Complications:
movement).
●​ Encourage sitting upright after meals to ●​ Hemolytic Disease of the Newborn (HDN)
prevent reflux & vomiting. → Jaundice, anemia, heart failure
●​ Hydrops fetalis (severe fetal edema)

ISOIMMUNIZATION (Rh
INCOMPATIBILITY)

IRON DEFICIENCY ANEMIA (IDA) IN

PREGNANCY
●​ Rh incompatibility occurs when an
Rh-negative mother carries an Rh-positive
fetus.
●​ If fetal blood enters maternal circulation, the Most common cause of anemia in pregnancy (due
mother’s immune system may produce to increased plasma volume expansion without
anti-D antibodies, which can attack fetal red sufficient hemoglobin increase).
blood cells in subsequent pregnancies,
leading to hemolytic disease of the newborn Causes:
(HDN).
●​ Increased iron demand for maternal and
Pathophysiology: fetal hemoglobin.
●​ Poor dietary iron intake.
●​ First Pregnancy: ●​ Blood loss (e.g., heavy menstrual periods
○​ The placenta usually prevents before pregnancy, multiple pregnancies).
mixing of maternal and fetal blood.
○​ If fetal Rh-positive blood crosses into Signs & Symptoms:
maternal circulation (e.g., due to
trauma, miscarriage, abortion, ●​ Fatigue, pallor, weakness
amniocentesis, or childbirth), the ●​ Shortness of breath
Rh-negative mother’s immune ●​ Increased risk of preterm birth, low birth
system recognizes it as foreign and weight, and perinatal mortality.
forms anti-D antibodies.
●​ Subsequent Pregnancies: Diagnosis:
○​ If another Rh-positive fetus is
●​ CBC: Microcytic, hypochromic anemia (low
conceived, maternal anti-D
MCV, low MCHC).
antibodies cross the placenta.
●​ Serum ferritin <15 ug/L (most sensitive test).
○​ These attack fetal RBCs, leading to
●​ Serum iron: Low.
hemolytic anemia and hydrops
fetalis in severe cases.
Treatment:
Risk Factors:
●​ Iron supplementation (ferrous sulfate)
●​ Iron-rich diet (red meat, dark leafy greens,
●​ Maternal Rh-negative blood type
legumes).
●​ Previous sensitization events: miscarriage,
abortion, ectopic pregnancy, invasive
procedures (e.g., amniocentesis), trauma,
or blood transfusion.

Assessment & Diagnosis: MULTIFETAL GESTATION

pg.34 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
Types of Twins: ●​ Class IV: Symptoms even at rest, severe
cardiac failure.
●​ Dizygotic (Fraternal) – Two separate ova,
fertilized by two sperm. Signs of Cardiac Decompensation:
●​ Monozygotic (Identical) – One fertilized
ovum that splits into two embryos. ●​ Cough, dyspnea, palpitations, edema, heart
murmurs, rales.
Complications:
Management:
●​ Twin-to-Twin Transfusion Syndrome (TTTS)
●​ One twin (donor) gives blood to the other ●​ Monitor cardiac function closely.
(recipient), leading to anemia in donor and ●​ Avoid excessive weight gain, sodium
heart failure in recipient. restriction, bed rest if needed.
●​ Fetal Demise: ●​ Medications as needed (diuretics,
○​ If one twin dies, the surviving twin is beta-blockers, anticoagulants).
at risk of neurologic damage due to
clotting complications.
○​ Preterm birth, low birth weight,
increased congenital anomalies.
INDICATION FOR CS
Diagnosis:

●​ Rapidly growing uterus, elevated AFP

levels, multiple fetal heart tones. Maternal Indications:
●​ Ultrasound confirms multiple fetuses.
●​ Previous C-section (depending on type &
Management: number).
●​ Placenta previa or abnormal placentation.
●​ Close monitoring, bed rest, early delivery if ●​ Uterine rupture risk (prior myomectomy,
complications arise classical incision).
●​ Cesarean section if indicated (e.g., ●​ Severe preeclampsia or cardiac disease.
non-cephalic presentations).
Fetal Indications:

●​ Fetal distress (non-reassuring heart rate

patterns).
●​ Malpresentation (e.g., breech, transverse).
CARDIAC DISEASE IN PREGNANCY ●​ Macrosomia with risk of shoulder dystocia.

Other Indications:
Can be congenital or acquired (e.g., from rheumatic
heart disease). ●​ Multiple gestation with malpresentation.​
●​ Active genital herpes infection.
●​ Increases cardiac workload, which can lead
to heart failure in severe cases.
MOST COMMON SEXUALLY TRANSMITTED
INFECTIONS (STI

Effects of Pregnancy on the Heart: Bacterial STIs:

●​ Increased blood volume & cardiac output 1.​ Chlamydia – Often asymptomatic; can
●​ Higher heart rate cause PID & infertility.
●​ Altered blood pressure 2.​ Gonorrhea – Can lead to PID, infertility,
neonatal conjunctivitis.
3.​ Syphilis – Primary (painless chancre),
secondary (rash, fever), tertiary (neurologic,
AHA Classification: cardiovascular damage).

●​ Class I: No limitation of activity, no

symptoms.
●​ Class II: Slight limitation; fatigue,
palpitations, dyspnea with exertion.
●​ Class III: Marked limitation; symptoms with Viral STIs:
minimal activity.

pg.35 l HENSON, C.B.

ZARI | NOTES IN MATERNAL AND CHILD NURSING (AT RISK)
1.​ HIV – Affects the immune system; can be
transmitted perinatally.
2.​ Genital Herpes (HSV-2) – Painful blisters,
lifelong infection.
3.​ HPV – Genital warts, cervical cancer risk.
4.​ Hepatitis B – Affects the liver, transmitted
via blood & bodily fluids.

Parasitic & Fungal STIs:

1.​ Trichomoniasis – Greenish discharge, foul

odor, itching.
2.​ Candidiasis – Yeast infection, thick white
discharge.

Prevention & Management:

●​ Safe sex practices (condoms).

●​ HPV vaccination.
●​ Routine STI screening during pregnancy.

pg.36 l HENSON, C.B.