ANGELES UNIVERSITY FOUNDATION

Angeles City
College of Nursing

CARE OF MOTHER, CHILD, ADOLESCENT (WELL CLIENTS) – NCM 0107

Second Semester, A.Y. 2020 – 2021

Module 2: Reproductive and Sexual Health

Whether or not someone is planning on childbearing, everyone is wiser for being

familiar with reproductive anatomy and physiology and his or her own body’s
reproductive and sexual health. Patients and their partners who are planning on
childbearing may become curious about reproductive physiology and the changes they
will undergo during pregnancy. Patients who are pregnant are also often interested
about physiologic changes, so nurses are frequently asked by both patients and their
partners about reproductive and gynecologic health (Callegari, Ma, & Schwartz, 2015)

Module Learning Outcome:

Upon completion of this module, the student should be able to:

1. Integrate concepts, theories, and principles of sciences and humanities in the

formation and application of appropriate nursing care during childbearing and
childrearing years.
2. Apply maternal and child nursing concepts and principles holistically and
comprehensively.

CONCEPT OF UNITIVE AND PROCREATIVE HEALTH

The unitive meaning is ordered toward the marital meaning. In fact, this union
is necessary for the consummation of the marriage. And the unitive meaning is
ordered toward the procreative meaning.

Procreation – to produce other of its kind; create; reproduce; to multiply

 It is a mechanism by which two living beings create a third living being that is
different from both the mother and the father.

Theories about Procreation

 1. Theory of EVOLUTION – asserts that all life forms are the result of
procreation.

 It is based on the idea that all species are related and gradually change over
time.
 All life is related and has descended from a common ancestor.
 The theory is defended on common features and ascending complexity.

2. STORY OF CREATION IN THE BOOK OF GENESIS – making of all thing from

nothing by an act of God.

 Single pair of ancestors (Adam and Eve)

 Man and woman are to be “two-in-one flesh”
 “increase and multiply”
 Stewards of creation

HUMAN SEXUALITY
 It is how people experience the erotic and express themselves as sexual
being.
 A person’s sexuality encompasses complex emotions, attitudes,
preferences, and behaviors related to expression of the sexual self and
eroticism.

Terminologies of Human Sexuality:

 Sex – biological male or female status; specific sexual behavior

 Sexuality – reflects human character and not solely genital nature

Aspects of Human Sexuality

1. Biologic Sex/Biologic Gender

 Term used to denote chromosomal sexual development i.e. male XY; female
XX

2. Gender/Sexual Identity
 The inner sense a person has of being a male or a female
 Sense of masculinity or femininity
 Influencing gender/sexual identity: Biologic focus and psychosocial focus

3. Gender-role Behavior
 The way a person acts as male or female including the expression of what is
perceived as gender appropriate behavior
 Causes: children who suspect that their parents wanted a child of the
opposite sex are more likely to adopt roles of the opposite sex
  Peers

Types of Sexual Identity

1. Heterosexual – one who is sexually attracted to persons of the opposite sex

 “straight”

Nursing Responsibilities:

1. Provision of information on safe sex practice at 10 – 12 years old (beginning

of puberty)

2. Homosexual – one who is sexually attracted to persons of the same sex

 “gay, lesbian” “LGBTQ”
 Men with men; women with women

Causes:

1. Unusual level of estrogen and progesterone in the utero

 Before puberty they feel “different”
 Not interested in opposite sex
 Adolescent – seek why they are “different”; homosexuals
 Young adulthood – afraid of stigma; secret commitment or “come out.

Nursing Responsibilities:

1. Be sensitive to their needs because they experience identify confusion

especially during adolescence.
2. Provision of additional counseling to avoid sexually transmitted infections
(STIs)
3. Obtain sexual history, provide information on prevention of STIs and signs
and symptoms.

3. Bisexual – one who is sexually attracted to persons of both sexes.

Nursing Responsibilities:

1. Prevention of STIs

4. Transsexual/Transgender – one’s belief that one is not the sex of one’s

physical body but of the opposite sex.
 Trapped in the wrong body
 Individual who, although of one’s biologic gender, feels as if he/she, be of
opposite gender

Sex-change Surgery
 Appear cosmetically as the gender they feel that they are
 Creation synthetic vagina or penis
 Not capable of reproduction
 No change in chromosomal structure
Sexua Health
 Integration of somatic/physical, emotional, intellectual and social aspects of
sexual well-being in ways that are positively enriching and that enhance
personality, communication, and love (World Health Organization)

Three Basic Elements of Sexual Health:

a. Capacity to enjoy and control sexual and reproductive behavior in
accordance with a social and personal ethics.
b. Freedom from fear, shame, guilt, false beliefs and other psychological
factors inhibiting sexual response and impairing sexual relationship
c. Freedom from organic disorders, diseases, and deficiencies that may
interfere sexual and reproductive function.

Sexual Normalcy
 The term sexual normalcy refers to the state wherein a
person is within the average of sexual capacity and expression,
within a framework of sexual meaning and or direction and
when he has a sense of well- being within that context.
Sexual Maturity
 Capacity to form a stable relationship with the opposite sex which is
physically and emotionally satisfying, and in which sexual intercourse forms
the main, though not only the mode of expression of love.

Factors Influencing Sexuality:

a. Developmental Level – development of sexuality begins with conception
and changes throughout the life span.
b. Culture
- All cultural groups have their own practices and values relating to
sexuality
- Diverse attitudes about husband/wife roles, childhood sexuality,
nudity, and appropriate sexual behavior
c. Religious values – it provides guidelines for sexual behavior and
acceptable circumstances for the behavior, prohibited sexual behavior,
consequences of breaking the sexual rules.
d. Personal Ethics/Beliefs – what a person views as bizarre/wrong may be
completely natural and right to another.
e. Health Status
- Some conditions or illnesses may interfere person’s expression of
sexuality such as: heart disease, diabetes mellitus, spinal cord injury,
surgical procedures, joint disease, chronic pain, sexually transmitted
infection, mental disorders, medications, and even pregnancy.

Human Sexual Responses (Masters and Johnson, 1966)

 600 men and women

 10,000 sexual activity
 The sexual experience is unique to each individual; how body responds to
sexual arousal has common features

1. Excitement Phase – begins with the onset of erotic feeling and sensation
which occurs with physical and psychological stimulation (sight, sound,
emotion, or thought) that causes parasympathetic nerve stimulation.

Two primary physiologic changes:

a. Vasocongestion – increased blood supply (arterial dilation and venous
constriction in genital area and other different body parts)
 b. Myotonia – an increased muscular tension (contraction)

Excitement Phase
Male Female
 Erection of the penis and  Erection of the clitoris and
nipples of the breast nipples of breast (increased
(parasympathetic nerve size = vasocongestion);
stimulation) sensitive to touch and
 Scrotal thickening and temperature; center of sexual
elevation of the testes (muscle arousal and orgasm in female;
contraction) increased arterial blood supply
 Presence of clear lubricating  Presence of mucoid fluid or
droplets at the urethral meatus lubrication of the vaginal walls
(bulbourethral gland) (Bartholin’s gland)
 Increased in temperature,  Vagina widens in diameter and
perspiration, RR, HR, and BP) increases in length
 Increased muscle tension in  Increase in size and change in
both smooth and skeletal the color of the labia, uterus,
muscle and breasts.
 Flushing of the skin
 Increased in temperature,
perspiration, RR, HR, and BP
 Increased muscle tension in
both smooth and skeletal
muscle

2. Plateau Phase – period during which sexual tension increases to levels

nearing orgasm, which may last from 30 seconds to 3 minutes.

Plateau Phase
Male Female
 Vasocongestion leads to full  The clitoris is drawn forward and
distention of the penis retracts under the clitoral
 HR (100 – 175 bpm) and RR (40 prepuce
cpm)  The lower part of the vagina
becomes extremely congested
(formation of “orgasmic platform”
 HR (100 – 175 bpm) and RR (40
cpm)

3. Orgasmic Phase/Orgasm – is the involuntary climax of sexual tension,

accompanied by physiologic and psychologic release. It lasts for 3 – 10
seconds; shortest stage in the sexual response cycle; intense pleasure
affecting the whole body.

Orgasmic Phase/Orgasm
Male Female
 Muscle contractions surrounding  A vigorous contraction of
the seminal vessels and prostate muscles in the pelvic area –
project semen into the proximal expels blood and fluid from area
urethra of congestion
 Contractions are followed  An average of 8 – 15
immediately by 3 – 7 propulsive contractions at intervals of one
“ejaculatory contractions”, every 0.8 seconds
 occurring at the same time interval According to Freud:
as in women which forces semen  Clitoral – masturbation/non
from the penis coital acts represent sexual
immaturity
 Vaginal – authentic, mature form
of sexual behavior
 Neurotic – does not achieve
orgasm through intercourse

4. Resolution Phase – is the 30-minute period during which the external and
internal genital organs return to unaroused state or pre-coital stage

Resolution Phase
Male Female
REFRACTORY PERIOD occurs Women do not go through this period
during which further orgasm is so it is possible for women to have
impossible from a few hours or additional orgasms immediately
days, depending on age and other after the first if properly stimulated
factors

SEX DIFFERENCES
Male Female
 More easily aroused  Require more physical and
 More satisfactory coitus, more psychological stimulation
rapidly than women  Proper mood or setting for
 Depend less upon ideal intercourse
circumstances for intercourse  Can achieve several consecutive
 Does not achieve second orgasms
orgasm

Concepts of Sexuality in the Philippines

1. Objections to foreplay before coitus. Reasons vary as some women feel that
prolonged foreplay, they are not treated like women anymore, not
respected as wives.
2. Sexual relations generally take at night.
3. Filipinos during act as being naked makes them feel “embarrassed” before
their husbands.
4. Arousal of body sensations is done through embracing, caressing, and
sometimes biting.
5. Females are expected to repress or restrict their interests in heterosexual
relations. A wife is not supposed to ask for sexual intercourse from her
husband. Thus, non-verbal behavior is resorted to imply their needs.

Assessing Sexual Health

 Assessment/History taking may include:

1. History, regularity, amount of menstrual flow.
a. Menarche
b. Interval
c. Duration
d. Associated Symptoms

2. Obstetrical/gynecological history
a. Gravita-ilang besis nagbuntis si patient
 b. Parity-ilan yung sa mga nagbutis nya yung nargreach ng age of
viability (24wks)
c. Term-napanganak ng kabuwanan
d. Pre term-less than 37 weeks
e. Abortion
f. Living children-ilan buhay
g. Multiple pregnancies- kambal,triplets

- Reports of discharges, pain, presence of lump, or change in color,

size and shape of genital organ;
- erectile dysfunction; failure to achieve orgasm; pain during
intercourse
3. Changes in urinary function
4. Birth control/medication taken
5. Sexual practices (sexually active; sexual partner – same/different gender;
number of sexual partners)
6. Occupation
7. Be respectful and sensitive about it

Possible Nursing Diagnosis

1. Altered Sexuality Patterns (includes sexual identity, sexuality, sexual

function)
- The state in which one expresses concern regarding one’s sexuality.

 Possible related factors:

- Impaired relationship with partner
- Fear of pregnancy
- Of acquiring an STI
- Of coitus following heart attack
- Lack of significant other
- Lack of privacy
- Body image disturbance
- Self-esteem disturbance
- Knowledge/skill deficit
- Altered body function, illness/medical therapy

2. Sexual Dysfunction – the state in which an individual experiences an

unsatisfactory, unrewarding, or inadequate change in sexual function.

 Possible related factors:

- Altered body structure or function secondary to disease process,
trauma, medical therapy (e.g. surgery, radiation)
- Pregnancy
- Recent childbirth
- Drugs

Safe sex practice

1. Be selective in choosing sexual partner; increased partners = increased

risk of STI
2. Do not use drugs and prostitutes
3. Inspect partner for any lesions (presence of abnormal draining = no sex)
4. Use of condom
5. Void immediately (aid in washing away contaminants on vulva and urinary tract)
6. Do not use sexual aids
7. Alert sexual partner; presence of STI = no sex
 Activity 1: Question and answer on the discussion board:
a. Are unitive and procreative health related?
b. Is a person’s sexuality related to sexual self and eroticism?

RESPONSIBLE PARENTHOOD

 Refer and read the textbook pp. 103 – 109

IMPORTANT THINGS TO CONSIDER
-Personal values
-Ability to use method correctly
-if method will affect enjoyment
-Financial Factors
-If couple relationship is short or long
-Prior experiences with contraception
-Future plans

Activity 2: Critical Thinking Question: Patient-centered care

A 17-year-old girl tells the nurse she wants to use a fertility awareness
method of contraception. How should the nurse best meet the girl’s learning
needs? Select the BEST answer and provide your rationale for choosing you
answer.

A. The nurse should teach her to record if she feels hot and
whether she is perspiring heavily.
B. The nurse should teach her to assess whether her cervical
mucus is thin and watery.
C. The nurse should teach her to monitor her emotions for sudden
anger or crying.
D. The nurse should teach her to assess whether her breasts feel
sensitive to cool air.

Responsible Parenthood (Menstrual Cycle and Family Planning Methods)

Planning the family requires knowing about human sexuality, being aware of one’s
own and one’s partner’s fertility and how the reproductive systems complement to
produce an offspring. Understanding these will enable a couple to decide how they can
achieve the number of children they want, by choosing to use a method that is suitable
for both of them, to their circumstances and their desired family size. This justifies the
need for including a discussion of menstrual cycle and family planning methods under
the topic of responsible parenthood.
CONCEPTS ON RESPONSIBLE PARENTHOOD
To better understand the relevant concepts on responsible parenthood, its definition
and underlying elements must be thoroughly realized. Moreover, the concept of family
as a basic unit of the society relates the responsibilities that it has to perform. The
succeeding portions of this section relates the topic’s definition and elements along with
the responsibilities associated with the family:

Definition
Responsible parenthood refers to the ability of the couple to raise a strong and
stable family, and make the family a reliable source of emotional, mental, social,
economic and moral support for the children. Part of responsible parenthood is the
ability to provide for the needs of the children and support them to achieve their
aspirations throughout their development. This includes keeping them healthy, well
educated, socially secure and well adjusted.

Elements of Responsible Parenthood

Considering the fact that responsible parenthood vitally involves the couple’s
willingness and dedication towards committed relationship, the elements of
responsible parenthood associate the parents’ roles in ensuring that responsibilities
are carried out satisfactorily. The following are the elements of responsible
parenthood:
1. Awareness and preparedness of duties and responsibilities of
parents
2. Promotion and protection of the rights of children
3. Nurturing parent and child relationship and observance of effective
communication
4. Effective shared home management
5. Practicing family planning
6. Promoting safe motherhood and child health nutrition
7. Fostering community involvement and participation

Family’s Relevance to Responsible Parenthood

Responsible parenting is a joint responsibility of a couple. This joint responsibility
starts from the decision on how many children they want and when to have them
up to the decisions and actions they take as they raise their children from babyhood
to adulthood. The proper development of children depends a lot on how well
parents perform their joint parenting responsibilities. Here are the concepts related
to the relevance of family to responsible parenthood:
1. The family is the basic unit of society. It is the wellspring of strength and
stability of a community and nation.
a. A family is traditionally seen as being made up of a father (husband), mother
(wife) and their child or children.
b. The family is the child’s immediate environment and serves as the
foundation for the child’s physical, social, mental, emotional and moral well
being.
c. The family is the source of the child’s sense of security and
belongingness, and the source of nurturance for his/her emotional and
economic growth.
d. Couples who are not married and only living together are also considered
as family because of their intense emotional bonds or affinity.
e. Families are the cornerstones of the society. The quality of the family
defines the quality of the nation.
f. Family structures are changing because of socio-economic and cultural
factors; as such, it needs to be protected from factors that may undermine
their integrity, well being and harmony.

2. Responsible parenthood is the ability and shared responsibility of husband

and wife to provide for and fulfill the aspirations of the children and the family.
Planning the number and timing of having children to make sure that they will be
healthy and well provided for is a part of responsible parenthood.
a. Responsible parenthood is the will and ability to respond to the needs and
aspirations of the family and the children. It involves the psychological
preparedness and health status of both parents as well as other
sociocultural and economic concerns.
b. It is the primary right and responsibility of parents to get actively involved
in the promotion of their children’s well being through the provision of
adequate care, attention and affection.

3. Responsible parenting is the assumption of the joint responsibility by husband

and wife in decisions about having and nurturing children, providing for the needs
of the family and attaining family aspirations, positively contributing to community
development. There are different parenting styles in the Philippines. They are
classified as:
a. Authoritarian. The parents have full authority over every aspect of their
child’s life.
b. Permissive. The parents do not set standards for their children
 c. Neglectful. The parents are not interested in their children’s affairs
d. Authoritative. The parents balance demands and discipline with
responsiveness

NATURAL AND ARTICIFICIAL FAMILY PLANNING METHODS

Family Planning is the voluntary and mutual or shared act of both couples to plan,
decide and take action on:
1. What their aspirations are for their family
and how to achieve them;
2. How many children to have;
3. When to have the next baby;
4. What methods to use to achieve their
desired number of children.

It is important to note that family planning is not only talking about contraceptives or
limiting or spacing the number of children for its own sake. It is all about the effort
of the couple to ensure that their family will have the quality of life they desire.
Ensuring that the family will achieve a desired quality of life can be achieved by the
use of planning methods which can be categorized as natural or artificial.
Natural Family Planning Methods
Natural family planning primarily involves a woman who monitors and records
different fertility signals during her menstrual cycle to work out when she is likely to
get pregnant. Methods that are within this category include the following:
1. Abstinence. This involves refraining from sexual relations. It is the most
effective way in preventing sexually-transmitted infections (STIs).
-0 FAILURE rate
-Difficult to adhere because of natural desire
 Periodic Abstinence. This is characterized by avoiding sexual
intercourse on days the woman may conceive.
2. Lactation Amenorrhea Method (LAM). Women can achieve a method of
contraception by way of breastfeeding. Because of the increase in
Progesterone.
Guidelines on breastfeeding as a method of contraception include the
following:
a. Breastfeeding is a natural suppressor of both ovulation and
menstruation
b. It is safe if the infant is under 6 months of age.
 c. The woman must totally breastfeed at least every 4 hours during the day;
and every 6 hours at night
d. There should be no infant’s supplemental feeding.
e. Menses has not returned.
3. Coitus Interruptus. This is also known as the withdrawal method.
-Oldest known method
-Produce coitus until ejaculation moment
-Disadvantage: residual
4. Post-coital Douching. This involves the use of douching following
intercourse.
-not effective no matter what solution, bc 90 sec. sperm swim.
FERTILITY AWARENESS METHOD
 Rely on detecting when woman is capable of being pregnant
 Consider length and survival time of sperm
 Length of time the ova is ripe for fertilization

5. Calendar Method. Abstain from sex during fertile.

-REGULAR MENSTRUATION LANG
-This is characterized by the use of a diary of six (6) menstrual cycles.
Guidelines include the following:
a. Calculate safe days
b. Subtract 18 on the shortest cycle
c. Subtract 11 on the longest cycle
6. Basal Body Temperature Method (BBM). Just before ovulation, the basal
body temperature (BBT) at rest falls about 0.5 F. At time of ovulation, BBT
rises 0.2 F.
Factors MIGHT alter:
-Illness
-stress
-shift work
-Interrupted sleep or oversleep
7. Cervical Mucus Method (Billing’s Method) (Spinnbakeit). This involves
monitoring of cervical mucus.
 Before ovulation, cervical mucus is thick and viscous.
 Ovulation- copius, slippery, thin, watery, stretches 1 inch
 Just before ovulation, cervical mucus increases, becomes thin, and
watery.
8. Two-Day Method. It is characterized by monitoring of secretions for two (2)
 days.
-require conscientious daily assessment
9. Symptothermal Method. This is a combination of cervical mucus method
and basal body temperature monitoring.
10. Standard Days Method.(Cycle beads) This involves the use of cycle beads
whose menstrual cycle ranges between 26 and 32 days.\
11. Ovulation Detection- Kit
-Detect mid cycles surge of LH surge that detect urine x 12-34hours before
ovulation
-Fairly expensive

Modern Artificial Family Planning Methods

The modern artificial family planning methods can be categorized
according to duration of effect of contraception. Some methods can
provide instant contraception while the others can give either a long-
duration or a permanent method of contraception.
1. Short Acting Methods
b. Barrier Method: Condoms. A condom is worn over the
penis during sexual intercourse thus preventing the sperm from entering
the vagina.
 c. Hormonal Methods
 Pills. They prevent ovulation and thicken the cervical mucus, which
prevents the sperm from entering the uterus.
 Injectables. They thicken the cervical mucus, which prevents
sperm from entering the uterus, stops ovulation and causes
changes in the uterus and fallopian tubes, which prevents
fertilization.

2. Long- Acting Methods

a. Intra-uterine device (IUD). It is a tiny device that is positioned into the
uterus to prevent pregnancy. It is a long-term, reversible, and one of
the most effective birth control methods.
b. Subdermal Implants. They are progestin only implants that are inserted
under the skin of the inner upper arm of women . They suppress
ovulation and thicken cervical mucus, thus hindering sperms from
passing through the cervical canal.

3. Permanent Methods. These are more appropriate for couples that have
decided to complete their number of children and cease further
pregnancies of the wife.
a. Bilateral Tubal Ligation (BTL). It is a surgical procedure that involves
blocking the fallopian tubes to prevent the ovum (egg) from being
fertilized. Cutting, burning or removing sections of the fallopian tubes or by
placing clips on each tube, can do the procedure.
b. Vasectomy. It is a surgical procedure for male sterilization or permanent
contraception. During the procedure, the male’s vas deferens are cut and
tied or sealed so as to prevent sperm from entering into the urethra and
thereby prevent fertilization of a female through sexual intercourse.

MENSTRUAL CYCLE

Refer to the narrated powerpoint presentation and read the textbook pp. 92 – 95

MENSTRUAL CYCLE
The woman’s reproductive health is a vital and crucial
consideration, which largely explains the need for inclusion of menstrual
cycle in the topic of reproductive health. Defining and differentiating
menstruation with other related terms would be covered on this section.
Definition
Latin word “mensis” means month
-Normal, predictable physiologic process
-Periodic uterine bleeding due to cyclic hormonal changes
-Purpose is to bring ovum to it’s maturity and renew a uterine tissue bed that would
be responsive to its growth should it be fertilize

Menstruation and the menstrual cycle are part of a woman’s reproductive

functions. The menstrual cycle starts from the first day of the woman’s menstrual
period and ends on the day before she begins her next menstrual period. Since
this happens regularly, it is called a cycle. The cycle includes the maturation and
release of a mature ovum from the ovary up to the shedding off of the
endometrium.
The length of the menstrual cycle varies for each woman. For some women, the
cycle is as short as 26 days or even fewer days. For others, it is as long as 32 days or
more. Irregular periods are common in girls who are just beginning to menstruate.
It may take the body a while to adjust to all changes taking place in the body.
However, on average, a menstrual cycle usually lasts about 26 to 32 days
Related Terms on Menstrual Cycle/ Menstruation:
Other related terms that may be associated with menstruation include the following:
2. Menarche. This is referred to as the first menstruation.
3. Menopause. It is termed as the permanent cessation of menstruation.
4. Polymenorrhea. It is described as frequent menstruation occurring at intervals
less than three weeks.
5. Oligomenorrhagia. This is characterized by a markedly diminished menstrual
flow nearing amenorrhea.
6. Amenorrhea. This is a cessation of menstrual flow.
7. Menorrhagia. It is excessive bleeding during regular menstruation.
8. Metrorrhagia. This is bleeding at completely irregular intervals (in between
menses).
Thelarche- breast
Adrenarche- hair
Amount of FLOW- ILANG NAPKIN

MENSTRUAL CYCLE’S STRUCTURES, HORMONES AND PHASES

There are structures that display a well-coordinated mechanism to allow for
menstrual cycle to commence. The roles of hormones have vital implication on each
phase of the process.

Structures
The menstrual cycle is the natural regular change that occurs in a woman’s
reproductive system (see Figure 1). The menstrual cycle is necessary in the production
of oocytes and preparation of the uterus for future pregnancy. Moreover, the
regulation of menstrual cycle is accomplished by the endocrine system. The
hypothalamus and the pituitary gland control the menstrual cycle. It is the
hypothalamus that triggers the pituitary gland to produce hormones, which in turn
stimulate the ovaries to make estrogen and progesterone. These hormones cause
the uterine lining thicker in preparation for pregnancy.
 Figure 1
Reproductive System

Hormones
The ovaries produce hormones predominantly estrogen, progesterone and
prostaglandin:
9. Estrogen: formation of secondary sex characteristics; development and
maturation of follicle.
10. Progesterone: preparation of the inner lining of the endometrium during
pregnancy; hormone of pregnancy
-Prevents further release of eggs
-DECREASE=MENSTRUATION
11. Prostaglandin: (eicosanoids forms arachidonic acid)
-frees the ovum inside the Graafian follicle; pathogenesis of menstrual pain
(Mittelschmerz) and cramps; stimulates uterine contractility and smooth
muscles (e.g. labor onset).

Moreover, a more detailed discussion of the effects of estrogen and progesterone can
be seen in the following section:

Estrogen’s effects:
1. Inhibits production of follicle-stimulating hormone (FSH).
2. Causes hypertrophy of the myometrium.
3. Controls the development of the female secondary characteristics
4. Increases quantity and pH of cervical mucus, causing it to become thin
 and watery and can be stretched to a distance of 10-13 cm.
5. Causes the uterus to increase in size and weight because of increased
glycogen, amino acids, electrolytes and water.
6. Increases libido that decreases the excitability of the hypothalamus,
which may cause an increase in sexual desire.
Progesterone’s effects:
1. Inhibits production of luteinizing hormone (LH).
2. Inhibits uterine motility.
3. Decreases muscle tone(contraction) of gastrointestinal and urinary
tracts.
4. Facilitates transport of the fertilized ovum through the fallopian tube.
5. Causes the endometrium to increase further its supply of glycogen,
arterial blood, secretory glands, amino acids and water.
6. Influences the cervix to secrete thick, viscous mucus.
7. The temperature decrease by -Celsius on the day after ovulation.
CORPUS LUTEUM- ASSOCIATED WITH INCREASE IN PROGESTERONE
COMPONENT OF MENSES
-BLOOD
-FRAGMENTS
-MICROSCOPIC

THEN CORPUS ALBICANS-MENSTRUATION WILL HAPPEN

 Uterus- proliferating and secretory
Ovary- Follicular and Luteal

Phases
The menstrual cycle (see Figure 2) occurs in a series of events that are reflections of
hormonal effects. It has four (4) phases namely:
1. Menstrual Phase
2. Follicular Phase (Pre- Ovulatory Phase)
3. Ovulation phase
4. Luteal Phase (Post Ovulatory Phase)
 Figure 2
Phases of Menstrual Cycle

Characteristics of Menstrual Cycle’s Phases:

1. Menstrual Phase (Day 1 to 5)
Menstrual phase (see Figure 3) begins on the first day of menstruation and
lasts until the 5th day of the menstrual cycle. The following events occur
during this phase:
a. The uterus sheds its inner lining of soft tissue and blood vessels, which
exits the body from the vagina in the form of menstrual fluid.
b. Blood loss of 10 ml to 80 ml is considered normal.
c. An experience of abdominal cramps is possible. These cramps are caused
by the contraction of the uterine and the abdominal muscles to expel the
menstrual fluid.

Figure 3
Menstrual Phase

2. Follicular Phase (Day 1 to 13)

Follicular phase (see Figure 4) also begins on the first day of menstruation,
but it lasts till the 13th day of the menstrual cycle. The following events occur
 during this phase:
a. The pituitary gland secretes a hormone that stimulates the egg cells in
the ovaries to grow.
b. One of these egg cells begins to mature in a sac-like-structure called follicle.
It takes 13 days for the egg cell to reach maturity.
c. While the egg cell matures, its follicle secretes a hormone that stimulates
the uterus to develop a lining of blood vessels and soft tissue called
endometrium.

Figure 4
Follicular Phase

3. Ovulation Phase (Day 14)

On the 14th day of the cycle, the pituitary gland secretes a hormone that
causes the ovary to release the matured egg cell. The released egg cell is
swept into the fallopian tube by the cilia of the fimbriae. Fimbriae are finger
like projections located at the end of the fallopian tube close to the ovaries and
cilia are slender hair like projections on each fimbria.

Figure 5
Ovulation Phase
 4. Luteal Phase (Day 15 to 28)
This phase begins on the 15th day and lasts till the end of the cycle (see
Figure 6). The following events occur during this phase:
a. The egg cell released during the ovulation phase stays in the fallopian tube
for 24 hours.
b. If a sperm cell does not impregnate the egg cell within that time, the egg
cell disintegrates.
c. The hormone that causes the uterus to retain its endometrium gets used
up by the end of the menstrual cycle. This causes the menstrual phase
of the next cycle to begin.

Figure 6
Luteal Phase

FERTILIZATION
The students will watch a video on fertilization, implantation,
identical twins and fraternal twins
https://www.youtube.com/watch?v=_5OvgQW6FG4
https://www.youtube.com/watch?v=qjiG8agWdhI

DEFINITION: It is the union of the sperm and the mature ovum in the outer third or
outer half of the fallopian tube.
ACROSOME REACTION- PAGPASOK SA EGG
General Considerations:

1. Mature ovum is capable of being fertilized for 12-24 hours after ovulation. Sperms
are capable of fertilizing even for 3-4 days after ejaculation.

2. Sperms once deposited in the vagina, will generally reach the cervix within 90
seconds after deposition.

3. Reproductive cells, during gametogenesis divide by meiosis; therefore, they contain

only 23 chromosomes, the rest of the body cells have 46 chromosomes.
Sperms have 22 autosomes and IX sex chromosomes or IY sex
chromosome; ova contain 22 autosomes and IX sex chromosome. The
union of an X - carrying sperm and a mature ovum results is a baby girl
(XX); the union of a Y – carrying sperm and a mature ovum results in a baby boy
(XY). Remember: Only fathers determine the sex of their children.

IMPLANTATION

Immediately after fertilization, a fertilized ovum or zygote stays in

the fallopian tube for 3 days during which time rapid cell division – “mitosis“
is taking place. The developing cells are now called “blastomere“ and when
there are already 16 blastomeres, it is now termed a morula. In this morula
form, it will start to travel to the uterus where it will stay for another 3-4 days.
When there is already a cavity formed in the morula, it is now called a
blastocyst. Fingerlike projections, called trophoblasts are the ones, which will
implant high on the anterior or posterior surface of the uterus. Thus,
implantation, also called nidation, takes place about 8-10 days after
fertilization. Once implantation has taken place, the uterine endothelium is now
termed decidua. It is divided into three portions:
 OUTER TROPOBLAST- PLACENTA
INNER CELL MASS- EMBRYO

1. decidua basalis - the part that lies directly under the embedded ovum.
 2. decidua capsularis - the portion that is pushed out by the embedded and
growing ovum.

2. decidua vera - the remaining portion which is not in immediate contact with
the ovum.

The three fetal membrane are the following:

1. Chorion – 1ST membrane to be form

-the outermost membrane of the growing embryo, or fertilized ovum
which serves as a protective and nutritive covering. Also known as the
chorionic membrane.
-Protect and support embryo during
-supports the sac contain amniotic fluid

2. Amnion or Amniotic membrane - a smooth slippery, glistening membrane that

forms beneath the chorion and lines the cavity. Also known as the
amniotic membrane. It is also called the bag of water because it is filled
with fluid known as the amniotic fluid.
Functions of amniotic fluid
a. keep the fetus at an even temperature.
 b. cushions the fetus against possible injury.
c. provide a medium in which the fetus can easily move.

3. Placenta - it is formed by the union of the chorionic villi and the decidua basalis.
It is a fleshy disk- like organ that measures 15-20 cm. in diameter and 2-
3 cm. in thickness late in pregnancy and weighs 500 g. at term.

Functions of Placenta
a. serves as the fetal lungs, kidney and GIT.
b. serves as a separate endocrine organ throughout pregnancy.
c. offers some protection to the fetus against invading microorganisms and
chemical substance.
8 WEEK- CORPUS LUTHIUM THEN HCG
 Activity 4: Exit tickets using a padlet
At the end of the discussion, the learner will answer a quick question about
fertilization.

EMBRYONIC AND FETAL STRUCTURES

 Germ layers
- Blastocyst
- Rubella infection (0-12 weeks high risk)
- All organ systems developed at 8 weeks (organogenesis) *prevent
patient

1. Endoderm
- Lining of pericardial, pleural, and peritoneal cavities, lining of GIT
and respiratory tract
- Tonsils, parathyroid, thyroid, thymus gland, and urinary system

2. Mesoderm
- Supporting structures of the body, dentin of teeth, upper portion of
the urinary system, reproductive system, heart, circulatory system,
blood cells, and lymph vessels.

3. Ectoderm
- CNS, peripheral nervous system, skin, hair, nails, sebaceous glands,
sense organs, mucous membranes of anus, mouth, nose, tooth
enamel, and mammary glands

Cardiovascular System:

o 16th day: single heart tube forms.

o 24th day: heart starts to beat

o 6th or 7th week: development of septum

o 7th week: development of valves
o 11th week: ECG (20th week or more accurate)
o 10th – 12th week: Doppler ultrasound (UTZ)
 o 20th week: fetal heart audible through stethoscope

Fetal Circulation

*****increase blood flow in fetal than adult

o 3rd week: fetal blood exchanges nutrients with maternal circulation

o Special structures”
- Ductus venosus – carry oxygenated blood = umbilical vein → inferior
vena cava
- Foramen ovale – connects the left and right atria bypassing fetal
lungs
- Ductus arteriosus – carry oxygenated blood = pulmonary artery →
aorta, bypassing fetal lungs
- Umbilical vein – carry oxygenated blood (from placenta)
- Umbilical artery – carry less oxygenated blood (to placenta)
Respiratory System
 o 3rd week – respiratory and digestive tracts exist as a single tube
o 4th week – septum begins to divide the esophagus from trachea (lung buds
appear on the trachea)
o 7th week – diaphragm divides the thoracic cavity from the abdomen completely
o If the diaphragm fails to close: stomach, spleen, liver, or intestines may herniate
(diaphragmatic hernia)

Nervous System

o 3rd to 4th week: active formation of nervous system

o All parts of the brain form intrauterine but matures at 5 – 6 y/o (cerebrum,
cerebellum, pons, and medulla oblongata)
o 24th week: ear is capable of responding to sound, eyes exhibit pupillary reaction
indicating sight

Endocrine System

o Fetal adrenal glands supply a precursor of estrogen synthesis by placenta

o Pancreas produces insulin needed by the fetus (insulin does not cross placenta)
o Thyroid and parathyroid glands have vital roles in metabolic function and calcium
balance

Digestive System

o 4th week: digestive tract separates from the respiratory tract

o 6th week: intestines
o 16th week: meconium formed
- Meconium consists of cellular wastes, bile, fats, mucoproteins,
mucopolysaccharides, and portions of vernix caseosa
- Dark green/black and sticky in texture
o GIT is sterile before birth (low in vitamin K)
o 36th week: GIT secretes enzymes essential in carbohydrate and protein
digestion
o Liver: active throughout gestation; filter between incoming blood and fetal
circulation; deposit site for fetal iron and glycogen

Musculoskeletal System

o 2nd week: cartilage prototypes provide position and support

 o 11th week: fetus can be seen moving through the UTZ
o 12th week: cartilage → bones
o 20th week: mother usually feels fetal movement
o QUICKENING

Reproductive System

o Child’s sex is determined at the moment of conception

o 6th week: gonads form (testes or ovaries)
o Testes = (+) testosterone – male organs
= (-) testosterone – female organs
o Testes forms in the abdominal cavity but descends into scrotal sac at 34 th – 38th
week
o 8th week: chromosomal analysis

Urinary System

o Forms intrauterine but not essential until birth (placenta)

o 4th week: rudimentary kidneys are present
o 12th week: urine is formed
o 16th week: urine is excreted in the amniotic fluid
o At term: urine rate is at 500 ml/day

Integumentary System

o Skin appears thin and translucent until adipose tissue forms at 36 weeks
o Lanugo – serves as insulation to preserve warmth in utero
o Vernix caseosa – serves as lubrication; prevents skin from macerating

Immune System

o 20th week: IgG class of immunoglobulin cross the placenta

o Temporary passive immunity against diseases (polio, rubella, rubeola, diphtheria,
pertussis, tetanus, infectious parotitis, hepatitis B) until 8 th moth of life
o Little or no immunity = herpes virus (WALA: chicken pox, cold sores, genital
herpes)
o IgA – found in colostrum and milk provides additional protection to the newborn

MILESTONES OF FETAL GROWTH AND DEVELOPMENT

1st Lunar Month (4 Gestation Weeks)

The fetus is 0.75 cm to 1 cm in length and weighs 400 mg.

Trophoblasts embed in decidua.
Chorionic villi form.
Foundations for nervous sytem,
genitourinary system, skin, bones, and lungs are formed.
Rudimentary heart appears as a bulge on the anterior surface
Back is bent so the head almost touches the tip of the tail
Buds of arms and legs begin to form.
Rudiments of eyes, ears, and nose appear.

2nd Lunar Month (8 Gestation Weeks)

 The fetus is 2.5 cm (1inch) in length and weighs 20 g.
Fetus is markedly bent. Primitive tail is regressing.
Head is disproportionately large, owing to brain development.
Organogenesis is complete.
Abdomen appears large due to rapid growth of fetal intestine
Sex differentiation begins.
Centers of bone begin to ossify.

3rd Lunar Month (12 Gestation Weeks)

The fetus is 7 cm to 8 cm in length and weighs 45 g.

Bone ossification centers are forming
Fingers and toes are distinct.
Placenta is complete
Fetal circulation is complete.
Heart is audible by Doppler
Kidneys secretes urine.

4th Lunar Month (16 Gestation Weeks)

The fetus is 10 to 17 cm in length and weighs 55 g to 120 g.

Sex can be determined by ultrasound
Lanugo is well formed
Nasal septum and palate close.
Fetus actively swallows amniotic fluid
Urine is present in amniotic fluid
Liver and pancreas are functioning.

5th Lunar Month (20 Gestation Weeks)

The fetus is 25 cm in length and weighs 223 g.

Lanugo covers entire body.
Fetal movements are felt by mother.
Heart sounds are perceptible by auscultation
Vernix caseosa appears

6th Lunar Month (24 Gestation Weeks)

The fetus is 28 cm to 36 cm in length and weighs 550 g.

Skin appears wrinkled.
Meconium is present as far as the rectum.
Eyebrows and fingernails develop.
Active production of lung surfactant begins

7th Lunar Month (28 Gestation Weeks)

The fetus is 35 cm to 38 cm in length and weighs 1200 g.

Skin is red.
Pupillary membrane disappears from eyes and the eyelids open.
Lung alveoli begins to mature and surfactant present in amniotic fluid.
The fetus has an excellent chance of survival.

8th Lunar Month (32 Gestation Weeks)

The fetus is 38 cm to 43 cm in length and weighs 1600 g.

Fetus is viable.
Fingerprints are set.
 Vigorous fetal movement occurs.
Subcutaneous fat begins to be deposited.

9th Lunar Month (36 Gestation Weeks)

The fetus is 42 cm to 48 cm in length and weighs 1800 g to 2700 g. (5-

6lbs.) Additional amount of subcutaneous fat are deposited.
Lanugo disappears
Amniotic fluid decreases
Sole of foot has only 1 or 2 crisscross creases

10th Lunar Month (40 Gestation Weeks)

The fetus is 48 cm to 52 cm in length and weighs 3000 g. (7-7.5 lbs)

Skin is smooth.
Fingernails extend over the fingertips
Creases on soles of feet cover at least 2/3 of the surface.
Vernix caseosa fully formed

Activity 5: Question and answer using the Discussion Board about embryonic
and fetal structures and milestones of fetal growth and development.
*******happen mostly-invitro fertilization

Physiologic and Psychologic Changes during Pregnancy

Physiologic changes that occur in the woman can be categorized as

local or systemic. Both the signs and symptoms of the physiologic changes of
pregnancy are used to diagnose and mark the progress of pregnancy. The
physiological changes during pregnancy are temporary so that as soon as
pregnancy is terminated, the woman eventually returns to the pre-pregnant state.
Father- who experience yung paglilihi

1. Local changes:

1.1. Uterus - the most obvious alteration in the woman's body during pregnancy is
the increase in the size of the uterus that occurs to accommodate the
growing fetus. Over the 10 lunar months of pregnancy, the uterus
increases in length from approximately 6.5 to 32 cm; in depth from 2.5 to
22 cm; and in width, from 4 to 24 cm. Its weight increases from 50 to
1000 gm. At the beginning of pregnancy, the uterine wall is about 1 cm.
thick and its cavity is barely enough to hold a 2 ml. bulk. By term, the
increase in size has become so extensive that the uterus can hold a 7 lb.
(3175 gm.) fetus plus 1000 ml. of amniotic fluid, or a total of about 4000
gm. The uterine growth results from:

1) increased vascularity and dilation of blood vessels;

2) production of new muscle fibers and fibroelastic tissues (hyperplasia)
and enlargement of pre-existing muscle fibers and fibroelastic tissues
(hyperthrophy).
3) Development of the decidua.
12,20,36
 Not only is there an increase in size and shape but there also occurs
a change in the consistency of the uterus. At about the 6th week of
pregnancy, the lower uterine segment just above the cervix becomes so soft
that when it is compressed between the examining fingers by bimanual
examination, the wall cannot be felt or feels as thin as tissue paper. This
extreme softening of the lower uterine segment is known as Hegar's
sign.PROBABLE
1.2. Cervix - In response to the increased level of circulating estrogen, the
cervix of the uterus becomes more vascular and edematous in
pregnancy; increased fluid between cells causes the cervix to soften
in consistency, and vascularity causes it to darken from a pale pink to
a violet hue. The glands of the endocervix undergo both
hyperthrophy and hyperplasia as they increase in number and
distend with mucus. A tenacious coating of mucus fills the cervical
canal. This mucus plug called the operculum seals out bacteria
during pregnancy and helps prevent infection in the fetus and
membranes. Softening of the cervix in pregnancy is so extensive that
whereas the consistency of a non- pregnant cervix may be compared
with that of the nose, the consistency of a pregnant cervix more
closely resembles that of an earlobe. This softening of the cervix is
called the Goodell's sign. Just before the onset of labor, when the
cervix takes on the consistency of butter, it is considered "ripe" for
delivery.

1.3. Vagina - The vascularity of the vagina increases beginning early in

pregnancy. The resulting increase in circulation changes the color of
the vagina from its normal light pink to a deep violet which is known
as the Chadwick's sign. Under the influence of estrogen, the
vaginal epithelium and underlying tissues become hypertrophic and
 enriched with glycogen; they loosen from their connective tissue
attachment in preparation for great distention at birth. This increase
in the activity of the epithelial cells results in a white vaginal
discharge throughout pregnancy. The vaginal secretions during
pregnancy fall from a ph of over 7 to 4 or 5 (due to an increased
lactic acid content caused by the lactobacillus acidophilus, which
grows freely in the increased glycogen environment) and therefore is
resistant to bacterial invasion. This change in ph unfortunately
favors the growth of Candida Albicans, a species of yeast like fungi.
A candidal infection is manifested by itching and burning sensation in
addition to a cream cheese like discharge, which if transmitted,
manifest itself as thrush in the infant's mouth.

1.4. Ovaries - Ovulation stops with pregnancy because of lack of activity of the
follicle stimulating hormone and the production of the human
chorionic-gonadotropin hormone.

1.5. Breast changes - A pregnant woman may experience a feeling of fullness,

tingling or tenderness because of the increased stimulation of breast
tissue by the high estrogen level in the body. As pregnancy progresses,
the breast size increases because of hyperplasia of the mammary alveoli
and fat deposits. The areola of the nipple darkens in color and its
diameter increases from 3.5 to 5 or 7.5 cm. The sebaceous glands of
the areola (Montgomery's tubercles) enlarge and become protruberant.
By the 16th week, a thin watery, high-protein fluid and the precursor of
breastmilk known as colostrum, may be expelled from the nipples.
2. Systemic Changes

2.1 Integumentary changes - As the uterus increases in size, the abdominal

wall must stretch to accommodate it. This stretching (plus possible
increased adrenal cortex activity) causes rupture and atrophy of small
segments of the connective tissue layer of the skin. This leads to pinkish
or reddish streaks appearing on the sides of the abdominal wall and
sometimes on the thighs. These streaks are called striae gravidarum.
In the weeks following deli- very, the striae gravidarum lighten to a
silvery white color called striae albicantes or atrophicae and
although permanent, become barely noticeable.

Extra pigmentation generally appears on the abdominal wall. A

brown line running from the umbilicus to the symphysis pubis and
separating the abdomen into a right and left hemisphere, this brown line
is known as the linea nigra. Darkened brown areas may appear in the
face particularly on the cheeks and across the nose. This is known as
melasma or chloasma or the mask of pregnancy. The increases in
pigmentation are due to melanocyte stimulating hormone secreted by
the pituitary. With the decrease in the level of the hormone after
pregnancy, these areas lighten and disappear.

Vascular spiders (small fiery red branching spots) are

sometimes seen on the skin of pregnant women particularly on the
thighs. These probably results from the increased level of estrogen in the
body, these may fade out but not disappear completely after pregnancy.

The activity of sweat glands increases throughout the body and is

manifested by an increase on perspiration which can become annoying
by the end of pregnancy. Palmar erythema (redness and itching) may
occur on the hands from the increase in estrogen level.

2.2. Respiratory system - As the uterus enlarges during pregnancy, a great

deal of pressure is put on the diaphragm and, ultimately, on the
lungs.This crowding of the chest cavity causes an acute sensation of
shortness of breath late in pregnancy, until ligthening relieves the
pressure.

A local change also that often occurs in the respiratory system,

is marked congestion or "stuffiness" of the nasopharynx, a response to
increased estrogen level.
2.3. Circulatory system - Changes in the vascular system are extremely
significant to the health of the fetus as they are important for adequate
placental and fetal circulation. To provide an adequate exchange of
nutrients in the placenta and for blood to compensate for blood loss at
delivery, the circulatory blood volume of the woman's body increases
at least 30 to 50 percent during pregnancy. As the plasma volume
first increases, the concentration of hemoglobin and erythrocytes may
decline, giving the woman a pseudoanemia.

To handle the increase in blood volume in the circulating

system, a woman's cardiac output increases significantly by 25 to 50
percent; the heart rate increases by ten beats per minute.

During the third trimester, blood flow to the lower extremities is

impaired by the pressure of the expanding uterus on veins and
arteries, which slows circulation. This decrease in blood flow in the
venous system leads to edema and varicosities of the vulva, rectum
and legs.

Palpitations in the early months of pregnancy are probably

caused by sympathetic nervous system stimulation; in later months,
they may result from increased thoracic pressure of the uterus against
the diaphragm. The level of circulatory fibrogen, a constituent of the
blood necessary for clotting as well as other clotting factors such as
VII, VIII, IX, X and the platelet count increases as much as 50 percent
during pregnancy, probably because of the increased level of
estrogen. This increase is a safeguard against major bleeding should
the placenta be dislodged and the uterine arteries or veins open up. In
most pregnant women, blood pressure actually decrease slightly
during the second trimester because of the lowered peripheral resist-
ance to circulation as the placenta expands rapidly.

2.4. Gastro-intestinal system - As the uterus increases in size, it tends to

displace the stomach and intestines towards the back and sides of the
abdomen. At about the midpoint of pregnancy, the pressure may be
sufficient to slow intestinal peristalsis and the emptying time of the
stomach, leading to heartburn, constipation and flatulence. This is also
about the same time the ovaries produce a hormone called relaxin,
which contributes to decreased gastric motility. Progesterone has also
an effect on smooth muscles such as that in the intestine making it less
active. Nausea and vomiting early in pregnancy known as morning
sickness is probably a systemic reaction to decreased glucose levels,
glucose being utilized in great quantities by the growing fetus, and
increased estrogen levels.

2.5. Urinary system - During pregnancy, the kidney must excrete not only the
waste products of the woman's body but those of the growing fetus as
well. Thus, urinary output gradually increases (about 60 to 80 percent)
and specific gravity of urine decreases during pregnancy. The pregnant
woman may notice an increase in urinary frequency during the first three
months until the uterus rises out of the pelvis and somewhat relieves
pressure on the bladder. Frequency of urination may return at the end of
pregnancy as lightening occurs and the fetal head exerts renewed
pressure on the bladder.

2.6. Skeletal system - As pregnancy advances, there is a gradual softening of

the pelvic ligaments and joints to allow for pliability and to facilitate
 passage of the baby through the pelvis at the time of delivery. This is
due to influence of the ovarian hormone, relaxin. The attempt of a
pregnant woman to change her center of gravity and make ambulation
easier, she tends to stand straighter and taller than usual. This stance is
referred to as the "pride of pregnancy."

2.6. Endocrine changes - The most striking change in the endocrine system
during pregnancy is the addition of the placenta as an endocrine organ,
producing large amounts of both estrogen and progesterone leading to
the suppression of follicle stimulating hormone and leutenizing hormone.

The thyroid glands is altered significantly. The gland enlarges in

pregnancy to compensate for the increased basal body metabolic rate by
about 20 percent. These thyroid changes along with emotion lability,
tachycardia, heart palpitations, and increased perspiration may lead to a
mistaken diagnosis of hyperthyroidism if pregnancy has not been
determined.

2.7. Temperature changes - Early in pregnancy, temperature increases slightly

because of the activity of the corpus luteum (the temperature elevation
that marked ovulation remains this way). As the placenta takes over the
function of the corpus luteum at about the 16th week, the temperature
generally decreases to normal at about this time.

2.8 Weight - A weight increase of about 25 to 40 lbs. is spread throughout

pregnancy. It may be distributed as follows:

Fetus .......................…………….. 7.5 lbs

Placenta ...................... …………. 1.5 lbs.
Amniotic fluid ................ …………2 lbs
Increased weight of uterus ………2.5 lbs
Increased blood volume ......……. 4 lbs.
Increased weight of breasts ... …. 1 1/2 to 3 lbs
Weight of additional fluid .... ……. 4 lbs
Fat and fluid accumulation ..……. 7 lbs

Psychological Tasks of Pregnancy

1. First Trimester: Accepting the Pregnancy

2. Second Trimester: Accepting the Baby
3. Third Trimester: Preparing for Parenthood

Confirmation of Pregnancy

Pregnancy is diagnosed on the basis of the symptoms reported by the

woman and signs elicited by a health care provider. These signs and symptoms
are traditionally divided into three classifications:

1. Presumptive Signs - These are least indications of pregnancy; taken as

single entities, they could easily indicate other conditions. These findings are
largely subjective in that they are experienced by the woman but cannot be
documented by the examiner.
 1.1. Amenorrhea - absence of menstruation. May also result from sudden
changes in environment, emotional stress, malnutrition, fatigue
and menopause.

1.2. Nausea and vomiting - May be due to gastro-intestinal tract irritation

or an emotional symptom.

1.3. Breast changes - May just signal another menstrual cycle.

1.4. Frequent urination - Could be the result of increased fluid intake,

excitement, cold climate or urinary tract infection.

1.5. Quickening - The first time life or fetal movement is felt by the mother.
It can sometimes be imitated by peristalsis or flatulence.

1.6. Fatigue - General feeling of tiredness which is a common complaint

even among those who are not pregnant.

1.7. Changes in abdominal shape - Tumors and as cited may also

change the shape of abdomen. Cushing's disease may even
manifest striae like marks on an enlarged abdomen.

2. Probable Signs - In contrast to presumptive signs of pregnancy, probable signs

can be documented by the examiner. Although they are more reliable
than the presumptive signs, they are still not positive or true diagnostic
findings.

2.1. Changes in reproductive organs - Due to the possibility of tumors or

inflammation, this symptom is considered as a probable sign of
pregnancy.

2.2. Basal body temperature elevation - Although this is considered as

having 97 percent accuracy as a diagnostic observation, it is
possible that the patient might have employed the wrong tech-
nique.

2.3. Positive biological and immunochemical pregnancy tests - A

form of diagnosis of pregnancy which can usually be made after
the 8th week. However, a hydatidiform mole can give a positive
result also.

2.3.1. Progesterone withdrawal test - An oral hormone containing

progesterone and estrogen is given to the woman for 2 or 3 days.
The effect of the medication takes place within 15 days following
the administration of the last dose. Physiologically, the increase in
these hormones will develop the endometrium and upon
withdrawal of the drug, menstruation will occur. But if the woman
is pregnant, the corpus luteum and the placenta will produce
sufficient hormones to keep the baby implanted, and there will be
no bleeding following withdrawal. Therefore, bleeding would
indicate that pregnancy has not occurred and the absence of
bleeding would indicate pregnancy.

2.3.2 Ultrasound determination - High frequency sound waves projected

toward a woman's abdomen are useful in diagnosing pregnancy.
If pregnancy is present, a characteristic ring indicating the
 gestational sac will be revealed on the oscilloscope as early as
the 6th week of amenorrhea. Incidentally, ultrasound is also
useful in demonstrating fetal maturity and indicating site of
implantation.

2.3.3. HCG test - For pregnancy testing HCG is measured in international

units. In the non-pregnant woman, no units will be detectable
because there are no trophoblast cells producing HCG. In the
pregnant woman, trace amounts of HCG will appear in the serum
as early as 24 to 48 hours following implantation.

Because all laboratory tests for pregnancy are inaccurate

to some degree, positive results from these tests are considered
probable rather than positive signs.

3. POSITIVE SIGNS OF PREGNANCY. There are only three positive signs of

pregnancy: fetal heart sound, fetal movements felt by the examiner and
visualization of the fetal outline by sonogram.

3.1. Auscultation of fetal heart sounds - although the fetal heart has been
beating since the 24th day after conception, it is audible by auscultation
of the abdomen with an ordinary stethoscope only at about 18 to 20
weeks of pregnancy. Fetal heart sounds are difficult to hear when
abdomen have a great deal of subcutaneous fat or there is greater than
normal amount of amniotic fluid (hydramnios). They are heard best
when the position of the fetus is determined by palpation and the
stethoscope is placed over the area of the fetus' back. A fetal heart rate
usually ranges between 120 and 160 beats per minute.

3.2. Fetal movements felt by the examiner - Movements of the fetus perceived
by the woman may be misleading. Those felt by an objective examiner
are much more reliable and constitute a positive sign of pregnancy.
Such movements may be felt by the 20 th - 24th week of pregnancy unless
the woman is extremely obese.

3.3. Visualization of fetus by ultrasound.

Activity 5: Practice test

A 20-item multiple choice quiz will be given through myCLASS Bigbluebutton.