MATERNAL AND CHILD FERTILIZATION occurs 24 hours after ovulation and occurs at the outer third of the fallopian

tube. The best time for fertilization is 15 to 18 hours following ovulation. IMPLANTATION occurs at the upper 2/3 of the uterus. The best time for implantation is betweem 6 to 10 days after ovulation. ESTROGEN is highest on the day before ovulation and PROGESTERONE is lowest at this time SELF BREAST EXAMINATION is best done on the 3rd day of menstrual cycle because estrogen is low causing decreased blood to flow to the breast. The PLACENTA is formed at 8th to 10th weeks, functional at 12 weeks and at term it weighs 1/6 of the newborns weight. Normal weight gain for pregnant woman would total to 22-27 lbs. CARDIAC VOLUME increases by 4050% causing increased CO, increased PULSE RATE by 10-15bpm. Slight decrease in BP (30%) during 2nd and 3rd trimester occurs, which is due to the vasodilating effect of estrogen. The 3 germ layers include ECTODERM, MESODERM AND ENDODERM. All organ systems are complete at 8th weeks of gestation. SURFACTANT starts to be secreted by alveolar cell at about 24th week of pregnancy. LECITHINSPHINGOMYELIN ration is 2:1 indicates lung maturity. NEURAL TUBE DEFECTS indicated by high alpha-protein levels in the amniotic fluid may occur because of lack of folic acid. QUICKENING or fetal movement can be detected by ultrasound as early as 11th week but can also be felt by the mother by 20th week. IgG maternal antibodies cross he placenta providing temporary passive immunity to the fetus, BARTHOLOMEWS RULE estimates AOG in weeks based on the abdominal landmarks: the SYMPHYSIS PUBIS, UMBILICUS, and XYPHOID. McDONALDs RULE estimates AOG in weeks by the formula: Fundic height(cm) x 8/7. NAEGELs RULE the most accurate estimate, estimates AOG in days by counting the 1st day of the LMP as day 1 and the day of the visit as the last day. FHR is heard by DOPPLER at 1oth week, using FETOSCOPE by the 16th week, and STETOSCOPE by 18 to 20th week. FETAL BIOPHYSICAL PROFILE: fetal breathing movement, fetal body movement, fetal tone, amniotic fluid index, non-stress test and placental grade

FETAL ATTITUDE refers to the degree of flexion a fetus assumes during labor or the reation of fetal parts to each other. ABORTION is the termination of pregnancy before 2 weeks of gestation ECTOPIC PREGNANCY is a cause of bleeding in 1st trimester of pregnancy. It is the gestation outside the uterus. HYDATIDIFORM MOLE a cause of 2nd trimester bleeding in pregnancy, is characterized by uterus large for gestational age, persistent bleeding and passage of grapelike clusters, elevated serum of hCG levels, absence of fetal heart sounds, and increased Nausea and Vomiting. INCOMPETENT CERVIX a cause of bleeding in the 2nd trimester, is the inability to of the cervix to remain closed long enough during pregnancy for fetal survival. PLACENTA PREVIA occurs when the placenta develops at the lower uterine segment and is characterized by painless profuse or scanty uterine bleeding that predisposes the mother to haemorrhage. LEFT SIDELYING or TRENDELENBURG position is advised. NEVER perform internal or rectal examination ABRUPTIO PLACENTA is the premature separation of a normally mplanted placenta and is characterized by sharp pain high at the fundus with bleeding. The patient is kep in LEFT LATERAL POSITION and I and rectal examination is avoided. LIGHTENING IS THE TERM REFFERING TO THE DESCENT OF THE fetal presenting part to the pelvis. The mother may experience shooting leg pains, increase vaginal discharge, and urinary frequency during lightening. It occurs earlier in primiparas than in multiparas because eof tighter abdominal muscles. CERVICAL DILATATION is the surest sign of true labor The presence of show is the surest sign of cervical dilatation The URGE TO PUSH is the surest sign of full cervical dilatation A bulging and shiny perineum is the the surest sign that the mother is ready to deliver. The 6Ps of labor: Passenger, Placenta, Power, Psyche, Passage and Position Mild preeclampsia is characterized by a BP of 140/90mmHg, proteinuria 1+ to 2+ and weight gain of more than 1lbs/week. Slight edema in the upper extremities are evident SEVER PREECLAMPSIA is characterized by BP of 160/110mmHg, proteinuria= 3+ to 4+, oliguria, pulmonary and peripheral edema, cerebral/visual disturbances, and hepatic dysfunction, periorbital edema, hyperreflexia(DTR 2+) ECLAMPSIA is defined by sign and symptoms of severe preeclampsia, but with convulsion

HELLP SYNDROME is a variation of of PIH named for the common symptoms = Hemolysis, Elevated Liver Enzyme, Low Platelets Premature Rupture Of Membrane(PROM) is the rupture and loss of the amniotic fluid that occurs before labor. Confirmed by (+) ferning and nitrazine paper test which turns blue d/t alkalinity of the amniotic fluid ERYTHROBLASTOSIS FETALIS involves the destruction of the fetal RBCs of an Rh positive fetus to Rh negative mother. HYDRAMNIOS is the presence of excessive amniotic fluid of 2000l(N is 500 to 1000ml). May indicate the presence of esophageal atresia of the fetus. HIV is transmitter transplacentally during vaginal delivery and during breastmilk VARICELLA-ZOSTER VIRUS is transmitted on 1st trimester and perinatal period CHLAMYDIA INFECTION is transmitted on the last trimester and causes neonatal conjunctivitis RUBELLA I is transmitted on the first trimester and early 2nd trimester. It may causes cataract, glaucoma, deafness, retinitis, and congenital heart defects. HERPES SIMPLEX is transmitted intraartally. Hence, CS is a preventive measure for mothers with active lesion HEPATITIS B is transmitted transplacentally or by contamination with maternal secretions during delivery. MATERNAL TORCH: Toxoplasmosis-Rubella-Cytomegalovirus-herpes type 2(genital herpes) are infectious diseases that cause serious harm to the embryo-fetus. The uterus returms to its original size and shape(80 gram at the end of puerperium) 4 to 6 weeks after delivery. The fundus decreases by 1 finger breadth/day from umbilicus LOCHIA RUBRA is the vaginal discharge present postpartum that is mostly blood and last for the first 3 days. LOCHIA SEROSA, pinkish to brownish that last for 4 to 10th day postpartum/ LOCHIA ALBA is yellowish to white from 10 to 14th week that may last for 21 days. The vagina is sft with few rugae after vaginal birth. The perineum develops edema and generalized tenderness. BLOOD VOLUME returns to prepregnant state after 1 to 2 weeks. The hCG and HPL are negligible by 24 hours. The hCG level is being monitored if retained placental fragments are suspected. POSTPARTAL HEMORRHAGE is defined by blood loss of greater than 500ml within 24 hours. Uterine Atony is the most frequent cause of postpartum haemorrhage.

Cracked and Fissured nipples in mastitis can be prevented by proper infant positioning and latching during breastfeeding, handwashing, and exposing nipples to air. POSTPARTAL BLUES may normally accompany postpartum wherein the mother experiences a temporary feeling of overwhelming sadness and is said to be caused by hormonal changes. POSTPARTAL DEPRESSION a feeling of extreme sadness and POSTPARTAL PSYCHOSIS separation from reality may need adequate therapy The vessels of umbilical cord should be composed of two arteries and 1 vein Loss of 10% birth weight in the 1st week is normal and regained in 10 to 14 days. CEPHALHEMATOMA is the collection of blood under the periosteum of the skull bone. CAPPUT SUCCEDANEUM is the edema of the sculp at the presenting part of the head that gradually disappears at about the 3rd day ERYTHEMA TOXICUM appears by the 3rd day after birth and disappears without treatment by the 7th day of life. COLOSTRUM is the thin yellow fluid produced by the breast starting on the 4th month of pregnancy up to the 2 to3 days after birth and is easy to digest by the newborn. MATURE BREASTMILK is produced by 3rd to 4th day postpartum BREASTFEEDING is contraindicated in infant with galactosemia, mothers with herpes lesions on nipples, maternal medications such as Litium and Methotrexate, mother exposed to radioactive compounds and breast cancer. MECONIUM should be passed out within 24 hours. TRANSITIONAL STOOLS appear by 2nd to 3rd day and colored greenish brown to yellowish brown. Milk stools appear by the 4th day and vary from yellow or gold and sour milk odor from breast fed infants to pale yellow/ light brown and offensive odor for formula fed infants.

CARE FOR WOMAN IN LABOR AND THE NEWBORN The biparietal diameter is the largest transverse diameter of the fetal head, measured between parietal bones. Cervical dilatation is stretching of the external os. Effacement is the thinning and shortening of cervix. The Anterior fontanel(diamond shape) closes by 12 to 18th month and the Posterior Fontanel(triangular shape) closes by 6 to 8 weeks after birth Molding, is the overlapping of the cranial bones, can be extensive but most newborn assumes their normal shape within 3 days. Fetal presentation refers to the part of the fetus that enters the pelvic inlet first and leads trhough bith canal during labor at term. The three presentation: Cephalic(head first) breech(feet or buttocks) and shoulder.