MATERNAL AND CHILD HEALTH NURSING

Important Points to Remember

Reproductive Health and Fertility• Ovulation occurs on approximately the 14th

day before the onset of the next cycle, not necessarily at a cycle’s midpoint.

• Calendar method involves calculating for fertile days and safe daysSubtract 18 from the shortest cycle (first

fertile day)Subtract 11 from the longest cycle (last fertile

day)A record of six menstrual cycles must be

obtained.

Reproductive Health and Fertility• Infertility is the inability to conceive or

sustain a pregnancy.• Subfertility exists when a pregnancy has

not occurred after at least 1 year of unprotected coitus.• Primary- no previous conceptions• Secondary-there was a previous viable

pregnancy• Sterility is the inability to conceive due to

a known condition (ex. absence of uterus)

Reproductive Health and FertilityHuhner Test (Post Coital Test)• A fertility test that evaluates the compatibility

of sperm and cervical mucus.• Cervical mucus pH is generally from 7 to 8.5.• Mucus can be stretched to at least 3.15

inches (8cm) before breaking.• Test is done several hours after intercourse.• Date should be close to the next ovulation.• A drop of mucus should contain a dozen or

sperm that swim with strong forward motion (good motility)

Reproductive Health and FertilityTubal Patency• The Ability of the egg to move from

the ovary to the uterus.• Hysterosalpingography• Previous damage to tubes can cause

infertility.• Usual cause is Pelvic Inflammatory

Disease.

PregnancySigns of Pregnancy1. Presumptive (Subjective) Signs

Breast changes (fullness, enlargement, color)

N & V Amenorrhea Urinary Frequency Quickening (18-20 wks) Skin Pigmentation (linea nigra, striae

gravidarum, chloasma)

PregnancySigns of Pregnancy2. Probable Signs

Serum HCG Chadwick’s sign Goodell’s sign Hegar’s sign Ultrasound (gestational sac) Ballottement Braxton Hicks contractions (at least 12th

wk) Fetal outline felt by examiner

PregnancySigns of Pregnancy2. Positive signs

Ultrasound (fetal outline) Fetal heart is audible Fetal movement felt by examiner

PregnancyCirculatory System During Pregnancy• Increase in blood volume (30-50%)• Pseudoanemia (first trimester)• Increase in heart rate (10 beats)• BP decreases slightly (second trimester),

but rises again (third trimester)• Blood fibrinogen increases• Blood lipids increase by one third• Serum cholesterol level increase by 90-

100%

PregnancyPregnancy Related Problems• Ectopic Pregnancy

Implantation occurs outside the uterusCan cause bleeding in pregnancyMost common site is the fallopian tube

(95%)Tubal scarring due to PIDCommon to women who smoke

PregnancyPregnancy Related Problems• Hyperemesis Gravidarum

N & V past the 12th week of pregnancySevere N &V that dehydration, ketonuria

and significant weight loss occurs within the first 12 wks of pregnancy

NPOIVF with vitamin BIf no vomiting after the first 24 hrs of

NPO, small amounts of clear fluid may be given

PregnancyPregnancy Related Problems• Hyperemesis Gravidarum

N & V past the 12th week of pregnancySevere N &V that dehydration, ketonuria

and significant weight loss occurs within the first 12 wks of pregnancy

NPOIVF with vitamin BIf no vomiting after the first 24 hrs of

NPO, small amounts of clear fluid may be given

PregnancyPregnancy Related Problems• PIH

Cause is still unknownOccurs in 5-7% of pregnanciesMultiple pregnanciesPrimipara younger than 20 and older

than 40Five or more pregnanciesHave underlying disease like heart

diseases or diabetes

PregnancyPregnancy Related Problems• Gestational HPN

BP 140/90Increase in systolic 30mmHg or

diastolic 15mmHg above prepregnancy level

No proteinuria or edemaReturns to normal after birth

PregnancyPregnancy Related Problems• Mild pre-eclampsia

BP 140/90Increase in systolic 30mmHg or

diastolic 15mmHg above prepregnancy level

Proteinuria 1-2+Weight gain of 2lbs/wk (2nd trimester),

1lb/wk (3rd trimester)Mild edema in upper extremities and

face

PregnancyPregnancy Related Problems• Severe pre-eclampsia

BP 160/110Proteinuria 3-4+Oliguria (500ml or less in 24hrs)Cerebral or visual disturbances

(headache, blurred vision)Epigastric painthrombocytopenia

PregnancyPregnancy Related Problems• Eclampsia

Seizure or coma accompanied by symptoms of pre-eclampsia

Cerebral edema

Labor and DeliveryFetal Presentation and Position• Attitude

The degree of flexion a fetus assumes during labor

Good Attitude: Complete flexion Head is flexed (chin touching the sternum) Arms flexed and folded into chest Thighs flexed into abdomen Calves are pressed against posterior

aspect of thighs

Labor and DeliveryFetal Presentation and Position• Engagement

Settling of the presenting part of the fetus into the pelvis

At the level of the ischial spinesFloating – presenting part not yet

engagedDipping – has not reached the ischial

spine yet

Labor and DeliveryFetal Presentation and Position• Station

Relationship of the presenting part to the level of the ischial spine

0 station – at level with ischial spine (engaged)

+3 - +4 station – presenting part is at the perineum (crowning)

Labor and DeliveryFetal Presentation and Position• Lie

Relationship between the long axis of the fetal body and the long axis of the mother’s body

Either horizontal (transverse) or vertical (longitudinal)

Longitudinal Lie: Cephalic Breech

Labor and DeliverySigns of Labor• Uterine Contractions

Begins irregularly but become regular and predictable

Felt first in the lower back and sweep around the abdomen in a wave

Continues regardless of woman’s activity

Increases in duration, frequency, and intensity

Achieves cervical dilation

Labor and DeliverySigns of Labor• Show• Rupture of Membranes

Sudden gush or scanty, slow seeping of clear fluid from the vagina

Can be advantageousRisk for intrauterine infection and

prolapsed cord

Labor and DeliveryStages of Labor1. First Stage

a) Latent Phase Contractions last 20-40 seconds Cervix dilates from 0-3cm Lasts 6hrs (nullipara) to 4.5hrs (multipara)

b) Active Phase Dilation from 4-7cm Contractions last 40-60 seconds every 3-5

mins Lasts 3hrs (nullipara) to 2hrs (multipara) Show and ROM may occur

Labor and DeliveryStages of Labor1. First Stage

a) Transition Phase Contractions last 60-90 seconds every

2-3 mins Cervix dilates from 8-10cm Show and ROM Full dilatation N & V may sometimes be felt Irresistible urge to push

Labor and DeliveryStages of Labor2. Second Stage• Period from full dilatation and cervical

effacement to birth of infant• Takes about 1 hour• Crowning

Labor and DeliveryStages of Labor3. Third Stage• Placental stage• From birth of infant to delivery of

placenta• Sudden gush of blood, lengthening of

umbilical cord (placental separation)4. Fourth Stage• First 1 to 4 hrs after birth of the

placenta• Oxytocin is given

Congenital Heart Disorders1. Ventricular Septal Defect

Most common type of CHD (30%) Opening is present between the two

ventricles Left to right shunting of blood Right ventricular hypertrophy and

increased pulmonary artery pressure Postop – be alert for arrhythmias

Congenital Heart Disorders2. Atrial Septal Defect

Abnormal communication between two atria

More common in girls Can be caused by patent foramen

ovale Left to right movement of blood Ventricular hypertrophy and increased

pulmonary artery pressure

Congenital Heart Disorders2. Atrial Septal Defect

Abnormal communication between two atria

More common in girls Can be caused by patent foramen

ovale Left to right movement of blood Ventricular hypertrophy and increased

pulmonary artery pressure

Congenital Heart Disorders3. Atrioventricular Canal Defect

Incomplete fusion of the endocardial cushion

Low ASD and high VSD and distortion of the mitral and tricuspid valves

May have left to right blood flow or between all chambers of the heart

Common in children with trisomy 21 (50%)

Congenital Heart Disorders4. Aortic Stenosis

Prevents blood from passing freely from the left ventricle to the aorta

Increased pressure and hypertrophy of LV LA pressure increase Back pressure to pulmonary veins and

pulmonary edema Decreased CO:

Faint pulses Hypotension Tachycardia Inability to suck for long periods

Congenital Heart Disorders5. Tetralogy of Fallot

Four anomalies are present:• Pulmonary stenosis• VSD• Overriding aorta (dextroposition)• RV hypertrophy

Cyanosis Polycythemia Dyspnea