PERSONAL DATA

W Nare: N|||la
W Case #: 31305
W Age: 20 years o|d
W Var|la| slalus: 3|rg|e
W Nal|ora||ly: F|||p|ro
W Re||g|or: Rorar Calro||c
W 0ale ol adr|ss|or: Augusl 21, 2011
W Reasor lor adr|ss|or: Laoor pa|r
W Ved|ca| d|agros|s: 01P1 (1001) PuFT Cepra||c L|ve
8|rlr 0e||verd v|a N3v0 lo a ||ve lerr
oaoy ooy Apgar 3core 8,9 8|rlr We|grl 32.2Z grars
8ody Lerglr: 19crs.
W 0ale ard l|re ol assessrerl: Augusl 23, 2011; 12:00rr
W Allerd|rg prys|c|ar: 0r. Ju|a||l
W Adr|ll|rg prys|c|ar: 0r. Asl|||o
AMILY BACKGROUND
On the paternal grandparents, Lolo Dan and Lola Nera met in Cebu City.
They got married and had 2 oIIspring, 2 barangays Lolo Dan died at the age oI 86
years old with unknown cause while Lola Nera is still alive and have Hypertension.
The Iirst son has no known while the youngest son tom, have hypertension.
On the Maternal Grandparents, both Lolo Joey and Lola Mel came Irom
Kapolong, Davao del Norte, they become lovers and eventually got married. The
couple had 8 children to rear. Lolo Joey was a carpenter while Lolamel stay at home
took care oI their children. On 1975, Lolo Joey accidentally died due to Iall while
working at the age oI 43 years old. Lola Mel was still alive and have no known
disease since no monthly nor even annual medical checkup done.
On 1988, Alex 23 and Tom 25, met at Kapalong, Davao del Norte. They
become lovers Ior 6 months and decided to get married at 1989. They are blessed
with 3 oIIspring, 2 girls and 1 boy. Only our patient Nikita had a known illness and
being diagnosed with mild preeclampsia. Her other siblings have no known diseases.
SOCIOECONOMIC BACKGROUND
According to Nikita, her Iather is the breadwinner and the main source oI
income in their Iamily. Her Iather worked as a Iarmer earning 3,000-5,000 a month,
while her mother stays at home. She was able to Iinished high School level but
cannot pursue to study in college due to Iinancial constraints.
Nikita is dependent in her Iamily. AIter graduation she didn't Iind ways to
work, but rather helping her mother doing the household chores.
Nikita stated that the status oI their Iamily belong to a low class, because
her Iather does not have permanent job to sustain their basic needs. She added that
during her hospitalization the Iamily oI her live-in partner is the one supporting their
baby's need, paying the hospital bills and buy the prescribed medication.
ISTORY O PAST ILLNESS
According to the patient her mother told her that she was not Iully
immunized, she was only given Hepatitis B aIter birth at the provincial Hospital in
Kiblawan and Iailed to comply the rest oI immunizations due to lack oI knowledge oI
her mother about the importance oI immunizations and her mother said to her their
hometown was Iar Irom the health center and there were no health workers to check
and give vaccines to their barangay. She was Iully breastIed Ior 1 year as claimed.
During childhood days she experienced mumps, chickenpox, common colds and she
also claimed that she had no serious complications or chronic illnesses nor
hospitalizations.
On the second week oI January 2011 she experienced dizziness, morning
sickness, body malaise. She undergone checked up at the health center together with
her mother. She was asked to submit a urine specimen by the midwiIe and it was
conIirmed that she was pregnant.
On February 2011 she had her skin allergy Ior 1 week, she experienced
itchiness and redness and according to her this is because oI dried Iish, she also
claimed that she has no allergy in seaIood. She only applied ointment named
'asitatis advised by her mother. She did not seek or consult medical check-up.
ISTORY O PAST ILLNESS
Nikitita claimed that during pregnancy she had her prenatal check-up once in a
month and twice a month during 8th month and oItentimes in the 9th month oI pregnancy.
He had her immunization (Tetanus Toxoid). On 7th month oI June she experienced edema
on her lower and upper extremities. She also claimed no other symptoms such as blurred
vision, severe, headache, she did not remember her blood pressure during her check up at
the Health Center at Kapalong. She also claimed that she never had vaginal inIections,
diIIiculty in breathing and palpitations; she was advised to avoid soIt drinks and salty
Ioods and have proper exercise. She took medications Ferrous sulIate only once Ior
vomiting as prescribed by the doctor.
On June 2011 she had undergone check up at the health center because she
experienced burning sensation or pain whenever she urinates. She asked to submit Ior
urinalysis by the doctor as a requirement Ior monthly check up and was diagnosed oI
Urinary Tract inIection but no medication were given and advised to come back on the
Iirst week oI July.
On the Iirst week oI July, 2011, when she had her prenatal check-up she was
given medications Ior her UTI, Amoxicillin 500mg 3X a day Ior 1week and Vitamin (Fern
C) as prescribed by the doctor and took medications religiously . She also drinks milk
(Anmum) daily. On August 2011 the doctor said that she was already cured. She claimed
that she never take Vitamins or any supplement except Vitamin C. She also claimed that
she had no history oI chronic or serious complications.
ISTORY O PRESENT ILLNESS
On 7th month oI June Nikita experienced edema on her lower and upper
extremities. She also claimed no other symptoms such as blurred vision, persistent
vomiting, severe, headache, she also claimed that she did not remember her blood
pressure during her checked up at the Health Center at Kapalong. She also claimed that
she never had vaginal inIections, diIIiculty in breathing and palpitations; she was advised
to avoid soIt drinks and salty Ioods and have proper exercise. She took medications
Ferrous sulIate only once because oI vomiting as prescribed by the doctor.
On August 21 prior to admission the patient experienced clear vaginal
discharges and labor pain. She was brought at the Emergency Department at Kapalong
Hospital and was reIerred to Davao Regional Hospital Ior Iurther assessment and
management due to high risk oI her pregnancy.
On August 21 at 11;40pm she was admitted at Davao Regional Hospital per
wheelchair with reIerral in due to labor pain her blood pressure was checked with result oI
150/90mmHg. She was seen by doctor Astillo with I.E 6cms and with started IVF D5 LR
1L 120cc and was wheeled to the Delivery Room. At exactly 1:27AM she delivered
spontaneously to alive baby boy in cephalic presentation with good cry and placed over
her abdomen. She was diagnosed G1p1 (1001) Pregnancy Uterine Full term Cephalic in
Live birth delivered via NSVD to live term baby boy Apgar score oI 8 and 9 PROM, mild
pre- eclampsia Birth weight 32.27 grams Body Length: 49cms.
OBSTETRIC ISTORY
Nikita started her menarche at the age oI thirteen. According to her when
she had her Iirst menstruation, she Iollowed superstitious belieI just like not taking a
bath, jump 1st step on the stairs, a Gumamela Ilower washed on her Iace to avoid
pimples as claimed. She also claimed that these practices were inIluenced by her
mother. She had her period every month. The duration oI her menstruation is 4 to 6
days. She can consume 3 pads oI Ieminine napkin per day, not Iully soaked with
blood. But there are times that she experienced heavy menstruation. She seldom
experience dysmenorrhea.
On the 21st oI August 2011, she gave birth to her Iirst baby boy G1p1
(1001) at Davao Regional Hospital via Normal Spontaneous Vaginal delivery. She
claimed that there were no history oI miscarriage and no serious complications. She
also claimed that she did not use any contraceptives.
GENOGRAM
DEVELOPMENTAL TASK
Erickson`s stages oI Development
According to Erickson, the socialization process consists oI eight phases-
the eight stages oI man. These eight stages oI man were Iormulated through wide
ranging experience in psychotherapy. According to Erickson, 'psychological crisis
will arise iI an individual negates the central task designated Ior him/her. II an
individual Iails to achieve even one stage, he/she will not be able to complete the
next task or when the task is negative the Iollowing task will also become negative
and vice versa. These stages are conceived in an almost architectural sense each
stages support the next stage, and so on.
Stage Age Central Task Actual 1ustification
InIancy
Virtue: Hope
0 to 18 months Trust vs.
Mistrust
Nikita claimed that she was
breastIed by her mother.
During this stage she was
able to develop trust
because her individual
needs like breastIeeding
was given.
Early
Childhood
Virtue: Will
18 months to
3 years
Autonomy vs.
Shame and
Doubt
Nikita claimed that when
she reached the age oI two
years old, she was able to
deIecate on her own. She
was also given a chance to
practice dressing herselI
without assistance until she
can dress by herselI all
alone at the age oI three.
She was also trained by her
parents to eat alone. Nikita
also claimed that she was
being punished by spanking
but it was only seldom.
Autonomy was develop
during this stage, she was
trained to deIecate on her
own, given mild
assistance in taking a
dress until she was able
to do it on her own and
she was also trained to
eat by herselI. Although
there are times that she
gets punishment Irom her
mother via spanking, it
was only a seldom even.
Late
Childhood
Virtue:
Purpose
3 to 6 years Initiative vs.
Guilt
Nikita claimed that she
loves to play games during
her childhood and she oIten
plays with her cousin`s and
neighbor`s. She also stated
that she had enemies during
play time and she skips naps
during nap time. She
claimed that she was hard
headed and doesn`t take a
nap whenever she is ordered
to do so. She also claimed
that she sometimes ran
away Irom home just to
play and roam around with
Iriends. She also stated that
she was sent to school and
took up kinder at the age oI
six.
During this stage she
learned to decide by
herselI and she
developed initiative
by choosing Iriends
to play with. By
making her own
decisions like
disobeying or doing
orders, she also
develops conIidence
to herselI.
School Age
Virtue:
Competence
6 to 12
years
Indsustry
vs.
InIeriority
Nikita claimed that when
she started taking classes,
she never experienced
diIIiculty in making Iriends.
She also stated that she
study during her Iree time
but not always.
Industry was
observed by using
diIIerent kind oI
approach in
blending in with her
classmates, that`s
why she never had
any diIIiculty in
making Iriends. She
was also being
industrious by using
her Iree time to
study.
Adolescence
Virtue:
Fidelity
12 to 19
years
Identity vs.
Role
conIusion
She had her menarche
at the age oI thirteen.
She had crushes at
school and she had Iour
boyIriends, her last
boyIriend lasted Ior two
years that eventually
became her live in
partner. She gradually
stopped going out when
she had her partner and
started drinking at the
age oI eighteen. She
decided to stop her
schooling when she
Iound out that she was
pregnant.
During this stage
Nikita had her
menarche that
gives her an
identiIication oI
being a woman.
She had crushes
in opposite
gender that gives
a justiIication that
she develops her
identity as being a
woman.
oung
Adulthoo
d
Virtue:
Love
20 to 40
years
Intimacy
vs.
Isolation
Nikita claimed that
she was loved by her
live in partner and
parents. Nikita
claimed that her live
in partner took
responsibility oI her
pregnancy. Nikita
also stated that her
parents was mad at
Iirst but eventually
became calm aIter
the delivery oI the
baby, and then they
began accepting the
situation.
Understanding
and acceptance
are the keys in
developing
intimacy. She
developed
intimacy
because oI the
commitment oI
her live in
partner and the
understanding
gave by her
parents.
DEINITION O TERMS
W Corpus Luteum - is a temporary endocrine structure in mammals, involved in
production oI relatively high levels oI progesterone and moderate levels oI estradiol.
It is colored as a result oI concentrating carotenoids Irom the diet.
W Edema - is an abnormal accumulation oI Iluid beneath the skin or in one or more
cavities oI the body that produces swelling. Generally, the amount oI interstitial Iluid
is determined by the balance oI Iluid homeostasis, and increased secretion oI Iluid
into the interstitium or impaired removal oI this Iluid may cause edema.
W Embryo - is a multicellulardiploideukaryote in its earliest stage oI development, Irom
the time oI Iirst cell division until birth, hatching, or germination. In humans, it is
called an embryo until about eight weeks aIter Iertilization and Irom then it is instead
called a Ietus.
W Fundus- oI the uterus is the top portion, opposite Irom the cervix.Fundal height,
measured Irom the top oI the pubic bone, is routinely measured in pregnancy to
determine growth rates.
W Homans' sign - is a sign oI deep vein thrombosis (DVT). A positive sign is present
when there is pain in the calI or popliteal region with examiner's abrupt dorsiIlexion
oI the patient's Ioot at the ankle while the knee is Ilexed to 90 degrees.
DEINITION O TERMS
W Hemolysis - is the rupturing oI erythrocytes (red blood cells) and the release oI their
contents (hemoglobin) into surrounding Iluid.
W Linea Nigrais a dark line appearing longitudinally on the abdomen oI a pregnant
woman during the latter 24 weeks oI term. It usually extends Irom the symphysis
pubis midline to the umbilicus and sometimes as Iar as the sternum.
W Oliguria - is the low output oI urine. It is clinically classiIied as an output below 300-
500ml/day.
W Oncotic pressure - is a Iorm oI osmotic pressure exerted by proteins in blood plasma
that usually tends to pull water into the circulatory system. Throughout the body,
dissolved compounds have an osmotic pressure. Because large plasma proteins cannot
easily cross through the capillary walls, their eIIect on the osmotic pressure oI the
capillary interiors will, to some extent, balance out the tendency Ior Iluid to leak out
oI the capillaries. In other words, the oncotic pressure tends to pull Iluid into the
capillaries.
W Primipara - is a woman who has given birth to one child or who is giving birth Ior the
Iirst time.
DEINITION O TERMS
W Proteinuria -means the presence oI an excess oI serumproteins in the urine. The
protein in the urine oIten causes the urine to become Ioamy, although Ioamy urine
may also be caused by bilirubin in the urine (bilirubinuria), retrograde ejaculation,
pneumaturia (air bubbles in the urine) due to a Iistulaor drugs such as pyridium
W Renin - also known as an angiotensinogenase, is an enzyme that participates in the
body's renin-angiotensin system (RAS) also known as the Renin-Angiotensin-
Aldosterone Axis - that mediates extracellular volume (i.e., that oI the blood plasma,
lymph and interstitial Iluid), and arterial vasoconstriction. Thus, it regulates the body's
mean arterial blood pressure.
The Iemale reproductive
system (or Iemale genital system)
contains two main parts: the uterus,
which hosts the developing Ietus,
produces vaginal and uterine secretions,
and passes the anatomically male
person's sperm through to the Iallopian
tubes; and the ovaries, which produce the
anatomically Iemale person's egg cells.
These parts are internal; the vagina meets
the external organs at the vulva, which
includes the labia, clitoris and urethra.
The vagina is attached to the uterus
through the cervix, while the uterus is
attached to the ovaries via the Fallopian
tubes. At certain intervals, the ovaries
release an ovum, which passes through
the Fallopian tube into the uterus.
ANATOMY AND PYSIOLOGY
ANATOMY AND PYSIOLOGY
II, in this transit, it meets with sperm, the sperm penetrate and merge with
the egg, Iertilizing it. The Iertilization usually occurs in the oviducts, but can happen
in the uterus itselI. The zygote then implants itselI in the wall oI the uterus, where it
begins the processes oI embryogenesis and morphogenesis. When developed enough
to survive outside the womb, the cervix dilates and contractions oI the uterus propel
the Ietus through the birth canal, which is the vagina.
The ova are larger than sperm and have Iormed by the time an anatomically
Iemale person is born. Approximately every month, a process oI oogenesis matures
one ovum to be sent down the Fallopian tube attached to its ovary in anticipation oI
Iertilization. II not Iertilized, this egg is Ilushed out oI the system through
menstruation.
ANATOMY AND PYSIOLOGY
External
The external components include the mons pubis, pudendal cleIt, labia
majora, labia minora, Bartholin's glands, and clitoris.
W Mons Pubis
The mons pubis is the rounded Ileshy covering over the pubic symphysis,
the joint oI cartilage that unites the right and leIt pubic bones. Its appearance varies,
generally in relation to the overall proportion oI body Iat, and is more pronounced in
women than in men. The mons pubis cushions and protects the pubic bone, especially
during intercourse.
W Pudendal Cleft
The pudendal cleIt is a part oI the vulva, the Iurrow at the base oI the mons
pubis where it divides to Iorm the labia majora. In some human Iemales, the clitoral
hood and labia minora protrude through the pudendal cleIt.
ANATOMY AND PYSIOLOGY
W Labia Majora
The labia majora are two prominent longitudinal cutaneous Iolds that extend
downward and backward Irom the mons pubis to the perineum and Iorm the lateral
boundaries oI the pudendal cleIt, which contains the labia minora, interlabial sulci, clitoral
hood, clitoral glans, Irenulum clitoridis, the Hart's Line, and the vulval vestibule, which
contains the external openings oI the urethra and the vagina.
Each labium majus has two surIaces, an outer, pigmented and covered with strong,
crisp hairs; and an inner, smooth and beset with large sebaceous Iollicles.
Between the two there is a considerable quantity oI areolar tissue, Iat, and a tissue
resembling the dartos tunic oI the scrotum, besides vessels, nerves, and glands.
The Labia Majora are thicker in Iront, where they Iorm by their meeting the anterior
commissure oI the labia majora. Together with the connecting skin between them, they
Iorm the posterior commisure oI the labia majora or posterior boundary oI the pudendum.
W Labia Minora
The labia minora are two longitudinal cutaneous Iolds on the human vulva. They are
situated between the labia majora, and extend Irom the clitoris obliquely downward,
laterally, and backward on either side oI the vulval vestibule, ending between bottom oI the
vulval vestibule and the labia majora. In the virgin the posterior ends oI the labia minora
are usually joined across the middle line by a Iold oI skin, named the Irenulum
labiorumpudendi or Iourchette
ANATOMY AND PYSIOLOGY
W Bartholin`s Gland
The Bartholin's glands are two glands located slightly below and
to the leIt and right oI the opening oI the vagina. They secrete mucus
to lubricate the vagina and are homologous to bulbourethral glands in
males. However, while Bartholin's glands are located in the
superIicial perineal pouch in Iemales, bulbourethral glands are
located in the deep perineal pouch in males. They secrete mucus to
provide vaginal lubrication.
W Clitoris
The clitoris is a sexual organ that is present only in Iemale
mammals. In humans, the visible button-like portion is located near
the anterior junction oI the labia minora, above the opening oI the
urethra and vagina. In humans, the clitoris is the most sensitive
erogenous zone oI the Iemale, the stimulation oI which may produce
sexual excitement and clitoral erection.
ANATOMY AND PYSIOLOGY
Internal
An anatomically Iemale person's internal reproductive organs are the
vagina, uterus, Iallopian tubes, cervix and ovary.
W Vagina
The vagina is a Iibro muscular tubular tract leading Irom the uterus to
the exterior oI the body in Iemale mammals. The vagina is the place where
semen Irom the anatomic male is deposited into the anatomically Iemale
person's body at the climax oI sexual intercourse, commonly known as
ejaculation. Around the vagina, pubic hair protects the vagina Irom inIection
and is a sign oI puberty. The vagina is mainly used Ior sexual intercourse.
W Cervix
The cervix is the lower, narrow portion oI the uterus where it joins with
the top end oI the vagina. It is cylindrical or conical in shape and protrudes
through the upper anterior vaginal wall. Approximately halI its length is
visible, the remainder lies above the vagina beyond view. The vagina has a
thick layer outside and it is the opening where baby comes out during
delivery. The cervix is also called the neck oI the uterus.
ANATOMY AND PYSIOLOGY
W Uterus
The uterus or womb is the major Iemale reproductive organ oI humans. The
uterus provides mechanical protection, nutritional support, and waste removal Ior the
developing embryo (weeks 1 to 8) and Ietus (Irom week 9 until the delivery). In
addition, contractions in the muscular wall oI the uterus are important in ejecting the
Ietus at the time oI birth.
The uterus is a pear-shaped muscular organ. Its major Iunction is to accept a
Iertilized ovum which becomes implanted into the endometrium, and derives
nourishment Irom blood vessels which develop exclusively Ior this purpose. The
Iertilized ovum becomes an embryo, develops into a Ietus and gestates until
childbirth. II the egg does not embed in the wall oI the uterus, an anatomically Iemale
person begins menstruation and the egg is Ilushed away.
W Oviducts
The Fallopian tubes or oviducts are two tubes leading Irom the ovaries oI
Iemale mammals into the uterus. On maturity oI an ovum, the Iollicle and the ovary's
wall rupture, allowing the ovum to escape and enter the Fallopian tube. There it
travels toward the uterus, pushed along by movements oI cilia on the inner lining oI
the tubes. This trip takes hours or days. II the ovum is Iertilized while in the
Fallopian tube, then it normally implants in the endometrium when it reaches the
uterus, which signals the beginning oI pregnancy.
ANATOMY AND PYSIOLOGY
W Ovaries
The ovaries are small, paired organs that are located near the lateral walls
oI the pelvic cavity. These organs are responsible Ior the production oI the ova
and the secretion oI hormones. Ovaries are the place inside the anatomically
Iemale body where ova or eggs are produced. The process by which the ovum is
released is called ovulation. The speed oI ovulation is periodic and impacts
directly to the length oI a menstrual cycle.
AIter ovulation, the ovum is captured by the oviduct, aIter traveling down
the oviduct to the uterus, occasionally being Iertilized on its way by an incoming
sperm, leading to pregnancy and the eventual birth oI a new human being.
MENSTRUAL CYCLE
The menstrual cycle is the scientiIic term Ior the physiological changes that can
occur in Iertile Iemalehumans. The menstrual cycle, under the control oI the endocrine
system, is necessary Ior reproduction. It is commonly divided into three phases: the
Iollicular phase, ovulation, and the luteal phase.
Stimulated by gradually increasing amounts oI estrogen in the Iollicular phase,
discharges oI blood (menses) slow then stop, and the lining oI the uterus thickens.
Follicles in the ovary begin developing under the inIluence oI a complex interplay oI
hormones, and aIter several days one or occasionally two become dominant (non-
dominant Iollicles atrophy and die). Approximately mid-cycle, 2436 hours aIter the
Luteinizing Hormone (LH) surges, the dominant Iollicle releases an ovum, or egg in an
event called ovulation. AIter ovulation, the egg only lives Ior 24 hours or less without
Iertilization while the remains oI the dominant Iollicle in the ovary become a corpus
luteum; this body has a primary Iunction oI producing large amounts oI progesterone.
Under the inIluence oI progesterone, the endometrium (uterine lining) changes to prepare
Ior potential implantation oI an embryo to establish a pregnancy. II implantation does not
occur within approximately two weeks, the corpus luteum will involute, causing sharp
drops in levels oI both progesterone and estrogen. These hormone drops cause the uterus
to shed its lining and egg in a process termed menstruation.
PASES
W Menstruation Phase
Menstruation is also called menses or a period. The Ilow oI menses normally serves
as a sign that a woman has not become pregnant.
Levels oI estradiol (the main estrogen), progesterone, Iollicle-stimulating hormone
and luteinizing hormone during the menstrual cycle, taking inter-cycle and inter-
woman variability into account.
W ollicular Phase
This phase is also called the proliIerative phase because a hormone causes the lining
oI the uterus to grow, or proliIerate, during this time.
Through the inIluence oI a rise in Iollicle stimulating hormone (FSH) during the Iirst
days oI the cycle, a Iew ovarian Iollicles are stimulated. These Iollicles, which were
present at birth and have been developing Ior the better part oI a year in a process
known as Iolliculogenesis, compete with each other Ior dominance. Under the
inIluence oI several hormones, all but one oI these Iollicles will stop growing, while
one dominant Iollicle in the ovary will continue to maturity. The Iollicle that reaches
maturity is called a tertiary, or GraaIian, Iollicle, and it Iorms the ovum.
As they mature, the Iollicles secrete increasing amounts oI estradiol, an estrogen. The
estrogens initiate the Iormation oI a new layer oI endometrium in the uterus,
histologically identiIied as the proliIerative endometrium. The estrogen also
stimulates crypts in the cervix to produce Iertile cervical mucus, which may be
noticed by women practicing Iertility awareness.
W ;ulation Phase
During the Iollicular phase,
estradiol suppresses production oI
luteinizing hormone (LH) Irom the
anterior pituitary gland. When the egg
has nearly matured, levels oI estradiol
reach a threshold above which they
stimulate production oI LH. These
opposite responses oI LH to estradiol
may be enabled by the presence oI two
diIIerent estrogen receptors in the
hypothalamus: estrogen receptor alpha,
which is responsible Ior the negative
Ieedback estradiol-LH loop, and
estrogen receptor beta, which is
responsible Ior the positive estradiol-
LH relationship. In the average cycle
this LH surge starts around cycle day
12 and may last 48 hours.
An ovary about to release an egg.
The release oI LH matures the egg and weakens the wall oI the Iollicle in
the ovary, causing the Iully developed Iollicle to release its secondary oocyte. The
secondary oocyte promptly matures into an ootid and then becomes a mature ovum.
The mature ovum has a diameter oI about 0.2 mm.
AIter being released Irom the ovary and into the peritoneal space, the egg
is swept into the Iallopian tube by the Iimbria, which is a Iringe oI tissue at the end oI
each Iallopian tube. AIter about a day, an unIertilized egg will disintegrate or dissolve
in the Iallopian tube.
Fertilization by a spermatozoon, when it occurs, usually takes place in the
ampulla, the widest section oI the Iallopian tubes. A Iertilized egg immediately
begins the process oI embryogenesis, or development. The developing embryo takes
about three days to reach the uterus and another three days to implant into the
endometrium. It has usually reached the blastocyst stage at the time oI implantation.
W uteal phase
The luteal phase is also called the secretory phase. An important role is played
by the corpus luteum, the solid body Iormed in an ovary aIter the egg has been
released Irom the ovary into the Iallopian tube. This body continues to grow Ior some
time aIter ovulation and produces signiIicant amounts oI hormones, particularly
progesterone. Progesterone plays a vital role in making the endometrium receptive to
implantation oI the blastocyst and supportive oI the early pregnancy; it also has the
side eIIect oI raising the woman's basal body temperature. There is a noted secretion
oI prolactin towards the end oI the secretory phase.
AIter ovulation, the pituitary hormones FSH and LH cause the remaining parts
oI the dominant Iollicle to transIorm into the corpus luteum, which produces
progesterone. The increased progesterone in the adrenals starts to induce the
production oI estrogen. The hormones produced by the corpus luteum also suppress
production oI the FSH and LH that the corpus luteum needs to maintain itselI.
Consequently, the level oI FSH and LH Iall quickly over time, and the corpus luteum
subsequently atrophies. Falling levels oI progesterone trigger menstruation and the
beginning oI the next cycle. From the time oI ovulation until progesterone withdrawal
has caused menstruation to begin, the process typically takes about two weeks, with
14 days considered normal. For an individual woman, the Iollicular phase oIten varies
in length Irom cycle to cycle; by contrast, the length oI her luteal phase will be Iairly
consistent Irom cycle to cycle.
The loss oI the corpus luteum can be prevented by Iertilization oI the egg; the
resulting embryo produces human chorionic gonadotropin (hCG), which is very
similar to LH and which can preserve the corpus luteum. Because the hormone is
unique to the embryo, most pregnancy tests look Ior the presence oI hCG.
The placenta is an organ that
connects the developing Ietus to the
uterine wall to allow nutrient uptake,
waste elimination, and gas exchange
via the mother's blood supply. The
placenta Iunctions as a Ietomaternal
organ with two components; the Ietal
placenta , which develops Irom the
same sperm and egg cells that Iorm the
Ietus, whilst the maternal placenta,
develops Irom the maternal uterine
tissue.
TE PLACENTA
W Structure
In humans, the placenta averages 22 cm (9 inch) in length and 22.5 cm
(0.81 inch) in thickness. It typically weighs approximately 500 grams (1 lb). It
has a dark reddish-blue or maroon color. It connects to the Ietus by an umbilical
cord oI approximately 5560 cm (2224 inch) in length that contains two arteries
and one vein. The umbilical cord inserts into the chorionic plate. Vessels branch
out over the surIace oI the placenta and Iurther divide to Iorm a network covered
by a thin layer oI cells. This results in the Iormation oI villous tree structures. On
the maternal side, these villous tree structures are grouped into lobules called
cotyledons.
DEVELOPMENT O TE PLACENTA
W The initial stages oI human embryogenesis.
The placenta begins to develop upon implantation oI the blastocyst into the
maternal endometrium. The outer layer oI the blastocyst becomes the trophoblast
which Iorms the outer layer oI the placenta. This outer layer is divided into two
Iurther layers: the underlying cytotrophoblast layer and the overlying
syncytiotrophoblast layer. The syncytiotrophoblast is a multinucleated
continuous cell layer which covers the surIace oI the placenta. It Iorms as a
result oI diIIerentiation and Iusion oI the underlying cytotrophoblast cells, a
process which continues throughout placental development. The
syncytiotrophoblast (otherwise known as syncytium), thereby contributes to the
barrier Iunction oI the placenta.
The placenta grows throughout pregnancy. Development oI the maternal
blood supply to the placenta is suggested to be complete by the end oI the Iirst
trimester oI pregnancy (approximately 1213 weeks).
Placental Circulation
Maternal blood Iills the intervillous space, nutrients, water,
and gases are actively and passively exchanged, then
deoxygenated blood is displaced by the next maternal pulse.
W Maternal placental circulation
In preparation Ior implantation,
the uterine endometrium undergoes
'decidualisation'. Spiral arteries in decidua
are remodeleds so that they become less
convoluted and their diameter is increased.
The increased diameter and straighter Ilow
path both act to increase maternal blood
Ilow to the placenta. The relatively high
pressure as the maternal blood Iills
intervillous space through these spiral
arteries bathes the Ietalvilli in blood,
allowing an exchange oI gases to take place.
In humans and other hemochorialplacentals,
the maternal blood comes into direct contact
with the Ietalchorion, though no Iluid is
exchanged. As the pressure decreases
between pulses, the deoxygenated blood
Ilows back through the endometrial veins.
Maternal blood Ilow is approx
600700 ml/min at term.
W etoplacental circulation
Deoxygenated Ietal blood passes
through umbilical arteries to the
placenta. At the junction oI umbilical
cord and placenta, the umbilical arteries
branch radially to Iorm chorionic
arteries. Chorionic arteries, in turn,
branch into cotyledon arteries. In the
villi, these vessels eventually branch to
Iorm an extensive arteriocapillary
venous system, bringing the Ietal blood
extremely close to the maternal blood;
but no intermingling oI Ietal and
maternal blood occurs.
Endothelin and prostanoids cause
vasoconstriction in placental arteries,
while nitric oxidevasodilation. On the
other hand, there is no neural vascular
regulation, and catecholamines have
only little eIIect.
UNCTIONS O TE PLACENTA
W Nutrition and immunity
The perIusion oI the intervillous spaces oI the placenta with maternal blood
allows the transIer oI nutrients and oxygen Irom the mother to the Ietus and the
transIer oI waste products and carbon dioxide back Irom the Ietus to the maternal
blood supply. Nutrient transIer to the Ietus occurs via both active and passive
transport. Active transport systems allow signiIicantly diIIerent plasma
concentrations oI various large molecules to be maintained on the maternal and
Ietal sides oI the placental barrier.
Adverse pregnancy situations, such as those involving maternal diabetes or
obesity, can increase or decrease levels oI nutrient transporters in the placenta
resulting in overgrowth or restricted growth oI the Ietus.
IgG antibodies can pass through the human placenta, thereby providing
protection to the Ietusin utero.
W Endocrine function
In humans, aside Irom serving as the conduit Ior oxygen and nutrients Ior Ietus, the
placenta secretes hormones (secreted by syncytial layer/syncytiotrophoblast oI
chorionic villi) that are important during pregnancy.
Hormones:
uman Chorionic Conadotropin (hCC). The Iirst placental hormone produced is
hCG, which can be Iound in maternal blood and urine as early as the Iirst missed
menstrual period (shortly aIter implantation has occurred) through about the 100th
day oI pregnancy. This is the hormone analyzed by pregnancy test; a Ialse-negative
result Irom a pregnancy test may be obtained beIore or aIter this period. Women's
blood serum will be completely negative Ior hCG by one to two weeks aIter birth.
hCG testing is prooI that all placental tissue is delivered. hCG is only present during
pregnancy because it is secreted by the placenta, which is present only during
pregnancy. hCG also ensures that the corpus luteum continues to secrete progesterone
and estrogen. Progesterone is very important during pregnancy because when its
secretion decreases, the endometrial lining will slough oII and pregnancy will be lost.
hCG suppresses the maternal immunologic response so that placenta is not rejected.
uman Placental actogen (hP uman Chorionic Somatomammotropinj). This
hormone is lactogenic and growth-promoting properties. It promotes mammary gland
growth in preparation Ior lactation in the mother. It also regulates maternal glucose,
protein, Iat levels so that this is always available to the Ietus.
Estrogen is reIerred to as the "hormone oI women" because it stimulates the development
oI secondary Iemale sex characteristics. It contributes to the woman's mammary gland
development in preparation Ior lactation and stimulates uterine growth to accommodate
growing Ietus.
Progesterone is necessary to maintain endometrial lining oI the uterus during pregnancy.
This hormone prevents preterm labor by reducing myometrial contraction. Levels oI
progesterone are high during pregnancy.
Fetus attached to placenta,
approximately 12 weeks aIter Iertilization.
The Ietal stage commences at
the beginning oI the 9th week. At the start
oI the Ietal stage, the Ietus is typically about
30 millimetres (1.2 in) in length Irom crown
to rump, and weighs about 8 grams. The
head makes up nearly halI oI the Ietus' size.
Breathing-like movement oI the Ietus is
necessary Ior stimulation oI lung
development, rather than Ior obtaining
oxygen. The heart, hands, Ieet, brain and
other organs are present, but are only at the
beginning oI development and have
minimal operation.
Fetuses are not capable oI
Ieeling pain at the beginning oI the Ietal
stage, and may not be able to Ieel pain until
the third trimester. At this point in
development, uncontrolled movements and
twitches occur as muscles, the brain and
pathways begin to develop.
DEVELOPMENT O ETUS
eek 9 to 1
Week 16 to 25
A woman pregnant Ior the
Iirst time typically Ieels Ietal
movements at about 21 weeks,
whereas a woman who has already
given birth at least two times will
typically Ieel movements by 20 weeks.
By the end oI the IiIth month, the Ietus
is about 20 cm (8 inches).
Fetus at 40 weeks aIter Iertilization, about 20
inches (51 cm) head to toe.
The amount oI body Iat rapidly increases. Lungs
are not Iully mature. Thalamic brain connections,
which mediate sensory input, Iorm. Bones are
Iully developed, but are still soIt and pliable.
Iron, calcium, and phosphorus become more
abundant. Fingernails reach the end oI the
Iingertips. The lanugo begins to disappear, until
it is gone except on the upper arms and
shoulders. Small breast buds are present on both
sexes. Head hair becomes coarse and thicker.
Birth is imminent and occurs around the 40th
week. The Ietus is considered Iull-term between
weeks 37 and 40, which means that the Ietus is
considered suIIiciently developed Ior liIe outside
the uterus. It may be 48 to 53 cm (19 to 21
inches) in length, when born. Control oI
movement is limited at birth, and
Week 26 to 40
The urinary system is the
organ system that produces, stores, and
eliminates urine. In humans it includes
two kidneys, two ureters, the bladder,
the urethra, and two sphincter muscles.
URINARY SYSTEM
KIDNE
W The kidneys are bean-shaped organs that
lie in the abdomen, retroperitoneal to the
organs oI digestion, around or just below
the ribcage and close to the lumbar
spine. The organ is about the size oI a
human Iist and is surrounded by what is
called Peri-nephric Iat, and situated on
the superior pole oI each kidney is an
adrenal gland. The kidneys receive their
blood supply oI 1.25 L/min (25 oI the
cardiac output) Irom the renal arteries
which are Ied by the abdominal aorta.
This is important because the kidneys'
main role is to Iilter water soluble waste
products Irom the blood. The other
attachment oI the kidneys are at their
Iunctional endpoints the ureters, which
lies more medial and runs down to the
urinary bladder.
W The kidneys perIorm a number oI tasks,
such as: concentrating urine, regulating
electrolytes, and maintaining acid-base
homeostasis. The kidney excretes and re-
absorbs electrolytes (e.g. sodium,
potassium and calcium) under the
inIluence oI local and systemic
hormones. pH balance is regulated by
the excretion oI bound acids and
ammonium ions. In addition, they
remove urea, a nitrogenous waste
product Irom the metabolism oI amino
acids. The end point is a hyperosmolar
solution carrying waste Ior storage in the
bladder prior to urination.
Humans produce about 2.9 litres oI
urine over 24 hours, although this
amount may vary according to
circumstances. Because the rate oI
Iiltration at the kidney is proportional
to the glomerular Iiltration rate, which
is in turn related to the blood Ilow
through the kidney, changes in body
Iluid status can aIIect kidney Iunction.
Hormones exogenous and endogenous
to the kidney alter the amount oI blood
Ilowing through the glomerulus. Some
medications interIere directly or
indirectly with urine production.
Diuretics achieve this by altering the
amount oI absorbed or excreted
electrolytes or osmalites, which causes
a d|ures|s.
W Glomerulus is a capillary tuIt that is
involved in the Iirst step oI Iiltering blood
to Iorm urine. Surrounded by Bowma n's
capsule, the beginning component oI
nephrons in the vertebrate kidney. A
glomerulus receives its blood supply Irom
an aIIerent arteriole oI the renal circulation.
Unlike most other capillary beds, the
glomerulus drains into an eIIerent arteriole
rather than a venule. The resistance oI these
arterioles results in high pressure within the
glomerulus, aiding the process oI
ultraIiltration, where Iluids and soluble
materials in the blood are Iorced out oI the
capillaries and into Bowman's capsule.The
rate at which blood is Iiltered through all oI
the glomeruli, and thus the measure oI the
overall renal Iunction, is the glomerular
Iiltration rate (GFR).
W Nephron is the basic structural and
Iunctional unit oI the kidney. Its
chieI Iunction is to regulate the
concentration oI water and soluble
substances like sodium salts by
Iiltering the blood, reabsorbing what
is needed and excreting the rest as
urine. A nephron eliminates wastes
Irom the body, regulates blood
volume and blood pressure, controls
levels oI electrolytes and
metabolites, and regulates blood pH.
Its Iunctions are vital to liIe and are
regulated by the endocrine system by
hormones such as antidiuretic
hormone, aldosterone, and
parathyroid hormone. In humans, a
normal kidney contains 800,000 to
1.5 million nephrons.
NEPHRON
GLOMERULUS
The brain is the center oI the
nervous system. The brain is located in
the head, protected by the skull and close
to the primary sensory apparatus oI
vision, hearing, balance, taste, and smell.
Brains can be extremely
complex. The cerebral cortex oI the
human brain contains roughly 1533
billion neurons, perhaps more, depending
on age and sex,|linked with up to 10,000
synaptic connections each. Each cubic
millimeter oI the cerebral cortex contains
roughly one billion synapses. These
neurons communicate with one another
by means oI long protoplasmic Iibers
called axons, which carry trains oI signal
pulses called action potentials to distant
parts oI the brain or body and target them
to speciIic recipient cells.
CENTRAL NERVOUS SSTEM
ETIOLOGY
PREDISPOSING ACTORS
actors Actual Rationale
Heredity/Family
History oI
Hypertension or
Preeclampsia

Genetic predispositions increase

the risk because it can be
inherited Irom generation. The
tendency to develop preeclampsia
appears to run in
Iamilies.(Pilliteri,2003)
Nikita has a Iamily history oI
hypertension in her Iather side.
Age
Risk oI preeclampsia increase iI a
woman is younger than 20 years
old or older than 35 years at the
time oI pregnancy.(Pilliteri,2003)
Nikita is 20 years old.
Primigravidity
Statistics shows that preeclampsia
tends to occur most Irequently in
primiparas younger than 20 and
older than 35 years old.
(Pilliteri,2003)
Nikita is G1P1
Race AIrican-American women have higher rates oI
preeclampsia than Asian women. In general,
women had the highest prevalence risk Iactors
and poor pregnancy outcomes, white and Asian
women tended to have the lowest
prevalence.(Pilliteri,2003)
Nikita is a Filipino.
PRECIPITATING ACTORS
actors Actual Rationale
Diet
Excessive intake oI Iatty Ioods will
increase the lipid and cholesterol level in
the blood, thus this will lead to
hyperlipidemia. This will later cause the
accumulation oI Iree radicals in the
circulation leading to endothelial injury
causing narrowing oI the lumen oI the
blood vessels. Increase sodium intake will
cause increase intravascular oncotic
pressure leading to edema.
(Bare, Cheever,et.al, 2009)
Nikita loves to eat Iatty Ioods such as
humba and salty Ioods such as dried Iish.
Smoking The Iindings oI smoking apparently
protective eIIect on preeclampsia
should balance with these harmIul
eIIects. Nicotine present in cigarettes
initially causes a rapid release oI
adrenalize which aIIects are rapid
heartbeat, increased blood pressure
and rapid shallow breathing
Nikita doesn`t smoke.
Stress
Both the physical and emotional
stress makes the heart work harder
thus increasing the blood pressure and
increasing the risk oI heart disease.
( bare,cheever,et.al 2009)
Nikita stated that she experience
emotional stress during her Iirst
trimester oI pregnancy.
Obesity Weight is one oI the major causes oI
preeclampsia. Obesity can be
associated with a number oI metabolic
changes, including increase in the
blood lipids Iatty substances like
cholesterol and triglycerides that would
lead to the development oI the
hypertension.
Nikita weight is Irom 5`4 kilos and
was increased to 60 kilos during her
pregnancy.
SYMPTOMATOLOGY
Signs & Symptoms Actual Significance
Hypertension
Hypertensive disorders complicate
about 10. OI all pregnancies oI
these, approximately 1/3 is cause
by chronic hypertension and 2/3 is
due to preeclampsia. Pregnancy
induced hypertension is thought to
involve a decrease in placental
blood Ilow, leading to the release
oI toxic mediators that alter the
Iunction oI endothelial cells in the
blood. Blood pressure above
150/90mmhg.
(Smeltzer, Bare, 2004)
Nikita BP is 150/90 mmhg on the
day prior to the delivery oI the
baby.
Generalized Edema
Rapid weight gain due to
Iluid retention is another sign
oI preeclampsia. Excessive
Iluid in the extracellular space
can markedly impair normal
organ Iunction; blood vessels
allow to leak Irom the vessels
into the surrounding tissue;
increased opening oI vessel
walls to Iluid.
(Wikipidia,2011)
Proteinuria
Protein which is present is
due to increased permeability
oI the glomerular membrane.
It is maniIested by urine
protein excretion ~5mg in 24
hours. It increases the
possibility oI Ietal jeopardy.
(Wikipedia,2011)
Headache It indicates poor cerebral
perIusion and maybe a
precursor oI convulsion.
Oliguria Due to decreased glomerular
Iiltration rate (GFR) and renal
blood Ilow, so there is lowered
urine output and clearance oI
urine. It is maniIested by less
than 400ml oI urine output per
day.()
Blurred vision/ Visual
disturbances
Indicate arteriolar vasospasm
and decreased blood Ilow in the
retina.()
PATOPYSIOLOGY
The predisposing Iactors Ior preeclampsia are the Iollowing: Age, risk oI
preeclampsia increase iI a woman is younger than 20 years old or older than 35 years
at the time oI pregnancy. Genetic predispositions, there is an increase risk because it
can be inherited Irom generation. The tendency to develop preeclampsia appears to
run in Iamilies. Statistics shows that preeclampsia tends to occur most Irequently in
primiparas younger than 20 and older than 35 years old.
Precipitating Iactors: Stress- Both the physical and emotional stress makes
the heart work harder thus increasing the blood pressure. Diet high in saturated Iat,
trans Iat and sodium can contribute to the increase in high blood pressure.
The deIective placenta causes a Iailure oI the invading trophoblast to
express integrin cell adhesion molecules leading to an impaired trophoblast invasion
to the maternal spiral artery, which is responsible Ior placental blood supply. As a
result, inadequate placental blood Ilow occurs. During this event, the placenta
produces endothelin, these are substances that are toxic to the endothelium the
decrease in placental blood Ilow also causes placental degenerative aging, and
because there is a decrease in blood supply, the nutritional Ilow also decreases
causing an intrauterine growth restriction.
Endothelin causes vasospasm and endothelial damage. The decreased blood
supply in the kidney due to vasospasm causes glomerular degeneration which leads to
a decrease in Glomelular Filtration Rate (the rate at which substance are Iiltered Irom
the blood oI the glomeruli into the Bowman`s capsules oI the nephron). Since there is
a decrease oI GFR there will be an impaired Iiltration allowing the protein to be
excreted in the urine. Because the amount oI protein decreases the oncotic pressure
also decreases. Resulting to increase capillary permeability, allowing the Iluid to shiIt
Irom intravascular to intracellular space. The Iluid shiIting causes a generalized
edema. Pleural eIIusions also occur because oI Iluid shiIting leading to pulmonary
edema, which causes dyspnea.
There will be swelling oI erythrocyte due to the Iluid shiIting which will
later result to the erythrocyte to rupture, leading to hemolysis and because oI this;
there will be a decrease in Red Blood Cells. The Iluid shiIting decreases the plasma
volume, which increases the increase in hematocrit.
The decrease in blood supply stimulates the release oI rennin as part oI the
kidney`s compensatory mechanism. The rennin an enzyme released in the blood by
the kidney in response to stress, it reacts with a substance Irom the liver to produce
angiotensin. As the blood passes through the lung ACE converts the angiotensin I to
angiotensin II resulting to a generalized vasoconstriction which increases the blood
pressure. The release oI angiotensin II stimulates the andrenal cortex which results to
aldosterone production. Aldosterone promotes sodium re-absorption causing water
retention leading to oliguria. The decreased blood supply in the retina due to
vasospasm decreases retinal perIusion. As a result oI this Blurring oI vision and
scotoma occurs. The decreased blood supply oI the brain due to vasospasm causes a
decreased perIusion in the brain leading to ischemia which is maniIested by
headache. The endothelial damage causes intravascular coagulation. Platelet
aggregation and Iibrin deposition occurs. Prolonged platelet aggregation lowers the
platelet count leading to thrombocytopenia. The endothelial damage on the liver
causes hepatic edema. This is maniIested by right upper quadrant pain.
Management includes; Bed rest (lowers blood pressure and promotes
placental blood Ilow),
Corticosteroids, Magnesium sulIate (prevents seizures), Calcium channel
blockers (antihypertension), Fetal and placental birth (Ietal and placental birth is the
only deIinitive cure oI preeclampsia). II managed, maternal circulation will return to
its normal state resulting to a good prognosis.
II not managed, Iurther ischemia will cause seizure leading to eclampsia.
Further complications will arise, such as stroke leading to coma, and abruptio
placenta leading to bleeding and eventually maternal and Ietal death.
SCEMATIC DIAGRAM
SCEMATIC DIAGRAM
MEDICAL MANAGEMENT
DOCTOR`S ORDER
08/21/11
11:40
59 kg.
140/80mmHg
89 bpm
24 cpm
37 c
NPO
IVF D5LR 1L 30 gtts/min
Laboratory:
CBC
BT
PLT
U/A
Medications:
CeIuroxime 750mg
Hydralazine 500mg IVTT
Methyldopa 250mg
-Karen B. Angsino, RN
Lic. No. 0368852
8/22/11
1:30 AM Incorporate 30 'u oxytocin to 1L D5LR 30
gtts/min
2:00AM To HR-1
Decrease NA; Low Iat diet
VS q4
Continue IVF same rate
- Honey Let Q. Jumakit MD
Medications:
CeIuroxime 750mg IVTT q 8 x 3 dose then shiIt to
ceIuroxime 500mg TID; to BID
FeSO4 to OD
MeIenamic Acid 500mg to TID
NiIedipine 5mg to TID
Perineal Care BID
Must avoid urine spontaneously 6 postpartum
Astillo MD
Honey Let Q. Jumakit MD.
8/22/11
6:00AM TransIer to DPW
Continue medications,IVF
-Shiela Mae D. Nuez
G1P1 ( 1001) PU Cephalic live birth delivered via NSVD
to live term baby boy AS 8,9 BW: 32.27 gms BL: 49cm
PROM, Mild Preeclampsia
High-risk Evaluation Iorm
Principal Operation: RMLE & Repair