Research for Sotto

8/6/2019 Research for Sotto

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Fundal Height Measurement

How is the measurement of the fundal height related to how far along in gestation

you are?

If you think of your womb, the uterus, as shaped like a large pear with larger end up, the narrow end is

the cervix which crosses the back of the vagina to "empty" into the vagina. In this way, a baby can be

stored in the main body of the uterus, the "fundus"--the larger end of the pear shape--and then exit into


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the outside world through the dilating cervix and via the vagina. The whole path is collectively

referred to as the "birth canal," which is a medical slang term.

Before ultrasound, a measurement of the size of the uterus was the most reliable

way to document progression of growth (with serial

measurements) of the baby; the absolute measurement

also gave an indication to how far along the pregnancy

was. Of course, one can't measure the entire size of

the uterus from examining the abdomen, because some

of the uterus lies below the pubic bone, into the pelvis.

The best one can do is measure from the pubic bone to

the top of the uterus that can be felt. Since all of the

growth of the baby is in this part of the uterus anyway

(the fundus, or body of the uterus), neglecting the

cervix in the measurement isn't a big deal.

How The Measurement Is Done

The fundal height--measured from the top of the pubic bone to the top of the

uterus--is generally measured in centimeters, and it's a measurement, as you

might suspect, that should increase as the pregnancy continues toward your due

date. Even though the fundal height is generally a diagnostic tool held over from

the days before ultrasound, it is still useful in large clinics where the same patient

may not get the same doctor twice in a row for her prenatal visits.

There is no measurement more exact than ultrasound, and even this isn't perfect.

But the fundal height, recorded with each visit, is even more inaccurate. Many

obstetricians in private practice who see the same patients over and over (small

and solo practices), may not even record it, but merely record whether the size of

the uterus is compatible with the gestational age. A physician who is familiar with

his or her patients will generally know when a baby isn't growing right during the

many visits of the pregnancy. And if there is suspicion of a growth restricted baby

or an LGA (large for gestational age baby), then ultrasound is the standard of care

to sort out any worries--NOT A FUNDAL HEIGHT.

But the fundal height is very useful in the larger clinics, because many different

doctors will see a patient before the due date. Because there needs to be at least

some objective frame of reference among the different doctors, the fundal height

is still a good idea. It's not great, but is easy...and free. Ultrasound would make

more academic sense, but is prohibitive from a cost standpoint when attempted


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on every visit. Like no two scales reading the same weight the same, also no two

doctors are going to measure the same fundal height the same. But if a different

doctor gets a discrepancy that's wildly different from what was expected based on

the previous doctor's fundal height last visit, then ultrasound is justified. This is

not very exact science, but it works remarkably well in the larger clinics. Relying

on fundal height as above must take into account explainable discrepancies.

For instance, a baby who has "dropped" between the last visit and the current

one may show a fundal height less than last visit! A simple pelvic exam can

determine the descent of the baby's head into the maternal pelvis to explain

this.

If a baby's turned sideways, as often occurs in mid-pregnancy, the fundal height

can be unusually short for what's expected, because the greatest dimension lies

across the horizontal.

A breech baby, usually sitting up high in the uterus, will yield an unusually large

fundal height.

Twins (or more!) will give a FH way too big for the gestational age. In these

days ofAssisted Reproductive Technology, this is becoming more common.

These are all circumstances that can defuse concerns over abnormal fundal

heights. So it's obvious that it would not be a good idea to revise a due date

based on a fundal height.

The fundal height can be out of sync with what's expected for the gestational age

due to abnormal conditions:

Oligohydramnios--too little fluid, taking away from the entire mass effect,

leading to a smaller fundal height.

Hydramnios and polyhydramnios--to much fluid, indicating possibly genetic

problems or anatomical problems with the baby.

Abnormal position of the baby close to term. A sideways baby is forgiveable in

midpregnancy, but the later into the pregnancy the unusual position remains,

the more likely there could be an abnormality.

The old Charity Hospital trick I use (we used to get people landing there with noprenatal care), is to judge the height of the fundus in relation to the umbilicus

(belly button). Generally, the pregnancy is halfway (about 20 weeks) when the

fundal height is palpable (felt) at the umbilicus. For every finger's width above the

umbilicus the fundal height reaches, you can add a week. Likewise, below the

umbilicus, subtracting a week. But this relationship is only applicable between 15

and 25 weeks. Before and after that this relationship goes out the window.
http://www.gynob.com/art.htmhttp://www.gynob.com/art.htm


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In summary, the fundal height is an antiquated and sometimes obsolete method

of judging the appropriate growth of the baby during a pregnancy. It's best use is

in large clinics and when a patient presents as a surprise with no prenatal care.

But in small private practices, it is superseded by consistent same-physician

evaluations throughout the pregnancy.

FETAL HEART TONE by:

DOPPLER


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discovered by Austrian mathematician and physicist, Christian Doppler (1803-53).

Each fetal heart monitor uses a transducer or probe of varying MGHZ (millions of

cycles per second), usually 2 or 3, containing piezoelectric crystals which send

short sound pulses into the directed area of the body. Every time one of these

sound waves is sent the transducer (probe) pauses briefly and listens for the

returning echo at which time the fetal heart doppler determines the depth and

direction of each returning sound wave and converts the signal into thefetal

heartbeat you hear. This heartbeat is not your baby's actual heartbeat but a

reproduction

Fetoscope

This is a special type of stethoscope used for listening to a baby. There are many

types of fetoscopes available, and a regular stethoscope works as well. This can

usually be used after about 30 weeks

he term fetoscope can be used to refer to two different medical devices, each of

which is designed to provide information about a fetus and how well it is doing

inside an expecting mother's uterus. In the first sense, a fetoscope is a type

ofstethoscope which has been customized for use in listening to the fetal

heartbeat. The second sense refers to a type ofendoscope utilized in fetoscopy, in

which a doctor introduces a camera to the uterus to see the fetus.

In the sense of a type of stethoscope, a fetoscope is most commonly used

by midwives. To use the fetoscope, the wearer inserts the ear pieces, places one

end on the abdomen of the expecting mother, and cradles his or her forehead in

the forehead rest. Once the fetoscope has been moved into the right position, the

heartbeat should be audible, allowing the practitioner to determine whether or not

the fetus is in good health.

The fetoscope can also be equipped with instruments which can be used to takesamples from the fetus or the amniotic fluid. To use the device, the doctor makes

a small incision in the abdomen of the woman, inserts the tube, and gathers the

necessary data before withdrawing the fetoscope and sewing up the incision.

This device is used in situations where a woman's fetus may have birth

defects which cannot be detected with the use of other methods. It can carry a
http://www.fetaldopplerfacts.org/facts/dopplers/fetal-heartbeat-doppler-sounds.phphttp://www.fetaldopplerfacts.org/facts/dopplers/fetal-heartbeat-doppler-sounds.phphttp://www.wisegeek.com/what-is-a-fetus.htmhttp://www.wisegeek.com/what-is-the-uterus.htmhttp://www.wisegeek.com/what-is-a-stethoscope.htmhttp://www.wisegeek.com/what-is-an-endoscope.htmhttp://www.wisegeek.com/what-is-fetoscopy.htmhttp://www.wisegeek.com/what-is-a-midwife.htmhttp://www.wisegeek.com/what-is-the-abdomen.htmhttp://www.wisegeek.com/what-is-sewing.htmhttp://www.wisegeek.com/what-are-the-most-common-birth-defects.htmhttp://www.wisegeek.com/what-are-the-most-common-birth-defects.htmhttp://www.fetaldopplerfacts.org/facts/dopplers/fetal-heartbeat-doppler-sounds.phphttp://www.fetaldopplerfacts.org/facts/dopplers/fetal-heartbeat-doppler-sounds.phphttp://www.wisegeek.com/what-is-a-fetus.htmhttp://www.wisegeek.com/what-is-the-uterus.htmhttp://www.wisegeek.com/what-is-a-stethoscope.htmhttp://www.wisegeek.com/what-is-an-endoscope.htmhttp://www.wisegeek.com/what-is-fetoscopy.htmhttp://www.wisegeek.com/what-is-a-midwife.htmhttp://www.wisegeek.com/what-is-the-abdomen.htmhttp://www.wisegeek.com/what-is-sewing.htmhttp://www.wisegeek.com/what-are-the-most-common-birth-defects.htmhttp://www.wisegeek.com/what-are-the-most-common-birth-defects.htm


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very high risk of miscarriage, up to 12% in some cases, and is therefore only

recommended when it is medically necessary. Women who go into the hospital for

a fetoscopy should be aware that they will be asked to take muscle relaxants to

encourage the fetus to remain calm during the procedure, and they may feel

woozy when the fetoscopy is over. Rest is strongly recommended for two weeks

following the procedure to reduce the risk of developing complications.

What is newborn screening?

Newborn screening (NBS) is a simple procedure to find out if your baby has a

congenital metabolic disorder that may lead to mental retardation and even death

if left untreated.

Why is it important to have newborn screening?

Most babies with metabolic disorders look normal at birth. One will never know

that the baby has the disorder until the onset of signs and symptoms and more

often ill effects are already irreversible

When is newborn screening done?

Newborn screening is ideally done on the 48th hour or at least 24 hours from

birth. Some disorders are not detected if the test is done earlier than 24 hours.

The baby must be screened again after 2 weeks for more accurate results.

How is newborn screening done?

Newborn screening is a simple procedure. Using the heel prick method, a few

drops of blood are taken from the baby's heel and blotted on a special absorbent


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filter card. The blood is dried for 4 hours and sent to the Newborn Screening

Laboratory (NBS Lab).

How much is the fee for newborn screening?

P550. The DOH Advisory Committee on Newborn Screening has approved a

maximum allowable fee of P50 for the collection of the sample

When are newborn screening results available?

Newborn screening results are available within seven working days to three weeks

after the NBS Lab receives and tests the samples sent by the institutions. Results

are released by NBS Lab to the institutions and are released to your attending

birth attendants or physicians. Parents may seek the results from the institutions

where samples are collected. A negative screen mean that the result of the test is

normal and the baby is not suffering from any of the disorders being screened. In

case of a positive screen, the NBS nurse coordinator will immediately inform the

coordinator of the institution where the sample was collected for recall of patients

for confirmatory testing.

Who will collect the sample for newborn screening

Newborn screening can be done by a physician, a nurse, a midwife or medical

technologist.

Where is newborn screening available?

Newborn screening is available in participating health institutions (hospitals, lying-

ins, Rural Health Units and Health Centers). If babies are delivered at home,

babies may be brought to the nearest institution offering newborn screening.

What are the disorders included in the Newborn Screening Package?

1. Congenital Hypothyroidism (CH)

CH results from lack or absence of thyroid hormone, which is essential to growth

of the brain and the body. If the disorder is not detected and hormone

replacement is not initiated within (4) weeks, the baby's physical growth will be

stunted and she/he may suffer from mental retardation.

2. Congenital Adrenal Hyperplasia (CAH) CAH is an endocrine disorder that causes

severe salt lose, dehydration and abnormally high levels of male sex hormones in


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both boys and girls. If not detected and treated early, babies may die within 7-14

days.

3. Galactosemia (GAL)GAL is a condition in which the body is unable to process

galactose, the sugar present in milk. Accumulation of excessive galactose in the

body can cause many problems, including liver damage, brain damage and

cataracts.

4. Phenylketonuria (PKU)PKU is a metabolic disorder in which the body cannot

properly use one of the building blocks of protein called phenylalanine. Excessive

accumulation of phenylalanine in the body causes brain damage.

4. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def)G6PD deficiency is

a condition where the body lacks the enzyme called G6PD. Babies with this

deficiency may have hemolytic anemia resulting from exposure to certain drugs,

foods and chemicals.

What should be done when a baby is tested a positive NBS result?

Babies with positive results should be referred at once to the nearest hospital or

specialist for confirmatory testing and further management. Should there be no

specialist in the area, the NBS secretariat office will assist its attending physician.

Disorder ScreenedEffects

SCREENED

Effect if

SCREENED and

treated

CH (Congenital

Hypothyroidism

Severe Mental

RetardationNormal

CAH (Congenital

Adrenal

Hyperplasia)

Death Alive and Normal

GAL

(Galactosemia)

Death of

CataractsAlive and Normal

PKU

(Phenylketonuria

Severe Mental

RetardationNormal

G6PD

Severe

Anemia,

Kernicterus

Normal


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Promotion of Breastfeeding program / Mother and Baby Friendly Hospital

Initiative (MBFHI)

Realizing optimal maternal and child health nutrition is the ultimate concern of the

Promotion of Breastfeeding Program. Thus, exclusive breastfeeding in the first

four (4) to six (6) months after birth is encouraged as well as enforcement of legal

mandates.

The Mother and Baby Friendly Hospital Initiative (MBFHI) is the main strategy to

transform all hospitals with maternity and newborn services into facilities which

fully protect, promote and support breastfeeding and rooming-in practices. The

legal mandate to this initiative are the RA 7600 (The Rooming-In and

Breastfeeding Act of 1992) and the Executive Order 51 of 1986 (The Milk

Code). National assistance in terms of financial support for this strategy ended

year 2000, thus LGUs were advocated to promote and sustain this initiative. To

sustain this initiative, the field health personnel has to provide antenatal

assistance and breastfeeding counseling to pregnant and lactating mothers as

well as to the breastfeeding support groups in the community; there should also

be continuous orientation and re-orientation/ updates to newly hired and old

personnel, respectively, in support of this initiative.

What You Should Know

Mother's milk is the best food a baby can have in the first 6 months of life.

Why Breastmilk is Best:

1. It helps protect the baby against:

- diarrhea

- cough

- colds

- malnutrition

- other common illnesses

2. There is no need to prepare breastmilk.

3. It is always available at no cost.

4. It helps babies grow up with close bond to their mother.
http://portal.doh.gov.ph/ra/ra7600_roomingin_breastfeeding_acthttp://portal.doh.gov.ph/ra/ra7600_roomingin_breastfeeding_acthttp://portal.doh.gov.ph/eo/eo51_milk_codehttp://portal.doh.gov.ph/eo/eo51_milk_codehttp://portal.doh.gov.ph/ra/ra7600_roomingin_breastfeeding_acthttp://portal.doh.gov.ph/ra/ra7600_roomingin_breastfeeding_acthttp://portal.doh.gov.ph/eo/eo51_milk_codehttp://portal.doh.gov.ph/eo/eo51_milk_code


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5. It is easy to digest.

6. It is clean and has the right temperature.

Breastfeeding should start within 30 minutes after birth.

COLOSTRUM is the initial yellowish fluid that comes out from the breast in the first

2-3 days after birth. It is good for babies and helps to protect them against

infection.

When the baby is 6 months old, start giving other food in addition to breastmilk.

Continue to breastfeed sick babies.

A sick mother can still breastfeed her baby.

Breastfeeding mothers should eat nutritious food to become stronger.

Danger Signs

Some Breastfeeding Problems:

1. SORE NIPPLES

- This is more common in mothers who have short nipples.

- This may develop when the baby bites on the nipple.

- Prevention:

- In women with short or inverted nipples, squeeze the nipples several times a

day.

2. BREAST ABSCESS

What to do as Community Health Worker

Encourage breastfeeding. Advise mothers that frequent sucking is needed to

produce enough breastmilk for the baby's needs. Advise mothers to keep their

breasts always clean.

If the baby cannot suck or if the nipples are sore, teach the mothers the proper

way to milk the breast by hand.

1. Ask the mother to use both hands. Start at the base of the breast.

2. Then move your hands toward the nipple, squeezing the milk out of the nipple.

3. Place the breast milk in sterilized container.

4. Give it to the baby using a spoon or dropper.


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Teach working mothers how to store breastmilk to be used for subsequent

feedings.

1. Milk the breast by hand before going to work when the breast is full.

2. Place milk in a sterilized container.

3. Store in a cool place.

4. Give breastmilk within 24 hours.

Republic of the Philippines

Congress of the Philippines

Metro Manila

Fifth Regular Session

Begun and held in Metro Manila, on Monday, the twenty second day of July,

nineteen hundred and ninety-one.


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Republic Act No. 7600

An act providing incentives to all government and private health institutions with

rooming in and breastfeeding practices and for other purposes

Be it enacted by the Senate and House of Representatives of the Philippines in

Congress assembled:

SECTION 1. Title.- This Act shall be known as "The Rooming-In and Breastfeeding

Act of 1992."

SEC. 2. Declaration of Policy.- The Senate adopts rooming in as a national policy to

encourage, protect and support the practice of breastfeeding. It shall create an

environment where basic physical, emotional, and psychological needs of mothers

and infants are fulfilled through the practice of rooming-in and breastfeeding.

Breastfeeding has district advantages which benefit the infant and the mother,

including the hospital and the country that adopts its practice. It is the first

preventive health measure that can be given to the child at birth. It also enhances

mother-infant relationship.

Furthermore, the practice of breastfeeding could save the country valuable

foreign exchange that may otherwise be used for milk importation.

Breastmilk is the best food since it contains essential nutrients completely

suitable for the infant's needs. It is also nature's first immunization enabling the

infant to fight potential serious infection. It contains growth factors that enhance

the maturation of an infant's organ system.

SEC. 3. Definition of Terms.- For purposes of this Act, the following definitions are

adopted:

a) Age of gestation - the length of time the fetus is inside the mother's womb.

b) Bottlefeeding - the method of feeding an infant using a bottle with artificial

nipples, the contents of which can be any type of fluid.

c) Breastfeeding - the method of feeding an infant directly from the human breast.

d) Breastmilk - the human milk from a mother.

e) Expressed breastmilk - the human milk which has been extracted from the

breast by hand or by breast pump. It can be fed to an infant using a dropper, a

nasogatric tube, a cup and spoon, or a bottle.

f) Formula feeding - the feeding of a new born with infant formula usually by

bottlefeeding. It is also called artificial feeding.


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g) Health institutions - are hospitals, health infirmaries, health centers, lying-in

centers or puericulture centers with obstetrical and pediatric services.

h) Health personnel - are professionals and workers who manage and/or

administer the entire operations of health institutions and/or who are involved in

providing maternal and child health services.

i) Infant - a child within zero (0) to twelve (12) months of age.

j) Infant formula - the breastmilk substitute formulated industrially in accordance

with applicable Codex Alimentarius standards, to satisfy the normal nutritional

requirements of infants up to six (6) months of age, and adopted to their

physiological characteristics.

k) Lactation management - the general care of a mother-infant nursing couple

during the other's prenatal, immediate postpartum and postnatal periods. It deals

with educating and providing knowledge and information to pregnant and

lactating mothers on the advantages of breastfeeding, the physiology of lactation,

the establishment and maintenance of lactation, the proper care of the breast and

nipples, and such other matters that would contribute to successful breastfeeding.

l) Low birth weight infant - a newborn weighing less than two thousand five

hundred (2,500 ) grams at birth.

m) Mother's milk - the breastmilk from the newborn's own mother.

n) Rooming-in - the practice of placing the newborn in the same room as the

mother right after delivery up to discharge to facilitate mother-infant bonding and

to initiate breastfeeding. The infant may either share the mother's bed or be

placed in a crib beside the mother.

o) Seriously ill mothers - are those who are with severe infections, in shock, in

severe cardiac or respiratory distress or dying or those with other conditions that

may be determined by the attending physicians as serious.

p) Wet-nursing - the feeding of a newborn from another mother's breast when

his/her own mother cannot breastfeed.

Chapter 1

Rooming-In and Breastfeeding of Infants

SEC. 4. Applicability.- The provisions in this chapter shall apply to all private and

government health institutions adopting rooming-in and breastfeeding as defined

in this Act.


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SEC. 11. Continuing Education, Re-education and Training of Health Personnel.-

The Department of Health with the assistance of other government agencies,

professional and non-governmental organizations shall conduct continuing

information, education, re-education, and training programs for physicians,

nurses, midwives, nutritionist-dietitians, community health workers and traditional

birth attendants (TBAs) and other health personnel on current and updated

management.

Information materials shall be given to all health personnel involved in maternal

and infant care in health institutions.

SEC. 12. Information Dissemination to Pregnant Women.- During the prenatal,

perinatal and postnatal consultations and/or confinements of the mothers or

pregnant women in a health institution, it shall be the obligation of the health

institution and the health personnel to immediately and continuously teach, train,

and support the women on current and updated lactation management and infant

care, through participatory strategies such as organization of mothers' clubs and

breastfeeding support groups and to distribute written information materials on

such matters free of charge.

Chapter IV

Miscellaneous Provisions

SEC. 13. Incentives.- The expenses incurred by a private health institution in

complying with the provisions of this Act, shall be deductible expenses for income

tax purposes up to twice the actual amount incurred: Provided, That the deduction

shall apply for the taxable period when the expenses were incurred: Provided,

further, That the hospitals shall comply with the provisions of this Act within six

(6) months after its approval.

Government health institutions shall receive an additional appropriation

equivalent to the savings they may derive as a result of adopting rooming-in and

breastfeeding. The additional appropriation shall be included in their budget for

the fiscal year.

SEC. 14. Sanctions.- The Secretary of Health is hereby empowered to impose

sanctions for the violation of this Act and the rules issued thereunder. Such

sanctions may be in the form of reprimand or censure and in cases of repeated

wilful violations, suspension of the permit to operate of the erring health

institutions.


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SEC. 15. Rules and Regulations.- The Secretary of Health, in consultation with

other government agencies, professional and non-government organizations

concerned shall promulgate the rules and regulations necessary to carry out the

provisions of this Act.

SEC. 16. Repealing Clause.- All acts, laws, decrees executive orders, rules and

regulations or parts thereof, which are contrary to or inconsistent with this Act are

hereby repealed, amended or modified accordingly.

SEC. 17. Separability Clause.- If any clause, sentence, paragraph or part of this

Act shall be declared to be invalid, the remainder of this Act or any provision not

affected thereby shall remain in force and effect.

SEC. 18. Effectivity.- This Act shall take effect one hundred twenty (120) days after

publication in at least two (2) newspapers of general circulation.

Approved,

(Sgd.) Ramon V. Mitra (Sgd.) Neptali A. Gonzales

Speaker of the President of the Senate

House of Representatives

This Act which is a consolidation of Senate Bill No. 1466 and House Bill No. 34369

was finally passed by the Senate and the House of Representatives on February 5,

1992 and February 4, 1992, respectively.

(Sgd.) Camilo L. Sabio (Sgd.) Anacleto D. Badoy, Jr.

Secretary General Secretary of the Senate

House of Representatives

Approved: June 2, 1992

(Sgd.) Corazon C. Aquino

President of the Philippines


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MATERNAL & CHILD CARE

The mother and child are the most vulnerable members of the community.

Theyare the ones usually affected by the changes in the overall health situation.

The healthcondition of the mother and child is a very important indicator of the

adequacy of healthcare in the country.Maternal and child cares start long beforepregnancy and extendslong after infancy. However, the most critical period is

during childbearing until a fewyears after childbirth.

PRENATAL CARE

-This is essential for ensuring the overall health of newborns and their mothers

(Pilliteri, 2003).

-A good prenatal care results in proper monitoring of the progress of the

pregnancy (DOH, 1997)

Purposeo

Establish a baseline of present health

o

Determine the gestational age of the fetus

o

It checks the health condition of the mother and baby as they undergochanges

that take place from conception to the time the mother goesinto labor.

o

Monitor fetal development

o

Identify the woman at risk for complications by anticipating and

preventing problems before they occur

o

Provide time for education about pregnancy and possible dangers

Prenatal Visit

-A time to establish baseline data relevant to planning health-promotion


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strategies now and with every subsequent visit.

-It should be started during the first 3 months of pregnancy.

Health Teachings

Teaching the client regarding the presumptive, probable, and positive finding

of pregnancy.

Relating assessment information and health-promotion activities throughout

the pregnancy.

Obtaining a health history, including screening for the presence of teratogens

and any problems the woman may experience.

Instructing the client regarding the discomforts of early pregnancy during thefirst, second and third trimester of pregnancy.

Instructing regarding the danger signs of pregnancy.

The importance and proper breastfeeding technique should be included in the

health teaching

DIAGNOSING PREGNANCY

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

thewoman and the signs elicited by a health care provider.These signs

andsymptoms are traditionally divided into three classifications:

presumptive,probable, and positive.

Presumptive Signs of Pregnancy

Experienced by the woman but cannot be documented by the examiner.

1. Breast changes

2. Morning sickness

3. Amenorrhea

4. Frequent urination

5. Fatigue

6. Uterine enlargement

7. Linea nigra

Melasma

9. Striae gravidarum

Probable Signs of Pregnancy


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Can be documented by the examiner

1.Serum laboratory tests

2. Chadwicks sign

3. Goodells sign

4. Hegars sign5.Sonographic evidence of gestational sac

6. Ballotement

7.Braxton Hicks sign

8.Fetal outline felt by the examiner

Positive Signs of Pregnancy

True diagnostic finding

1.Demonstration of a fetal heart separate from the mothers

2.Fetal movement felt by the examiner3.Visualization of the fetus by ultrasound

HEALTHY PREGNANT WOMEN

A Healthy Pregnant Mother:

1. Eats enough to gain weight regularly.

- drinks 8 or more glasses of water a day

eats nutritious food

- a pregnant woman should have gained

1 kilogram - within the first 3 months of pregnancy5 kilograms - within the second three months of pregnancy

5 kilograms - within the last three months of pregnancy

2. Takes a bath everyday.

3. Visits the Health Center for regular monthly prenatal check-ups.

4. Has received 2 shots of tetanus toxoid during her pregnancy.

5. Does not smoke nor drink alcohol.

6. Stays away from the smoking persons.

7. Stays away from sick persons.8. Rests more and does less work than usual.

9. Takes food rich in calcium everyday.

HIGH RISK FACTORS

Pregnant mothers with any following high risk factors have a higher chance of


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encountering problems during pregnancy and delivery:

1. She is less than 17 years old or more than 35 years old.

2. She has more than four children.

3. She had severe bleeding from the vagina during her pregnancy.

4. She does not have a good history in her previous pregnancies like:

- two or more abortions

2 or more babies born before the expected delivery

- difficult delivery

- given birth to twins

- last baby was born dead or died soon after birth

5. She previously delivered by Ceasarean section.

6. Her baby was born less than 2 years ago.

7. She weighs less than 45 kgs. or more than 80 kgs.

8. She is very pale and looks tired.

9. She has tuberculosis, diabetes, heart, and/or kidney disease.

Health Teachings

1. Eat more nutritious food during pregnancy and location.

2. Avoid taking medicine unless prescribed by the doctor.

3. Breastfeed their babies by discussing the importance of breastfeeding.

4. Space pregnancy at least 2 years apart.

5. In women with short or inverted nipples, squeeze the nipples daily during

pregnancy. This will make it easier for their child to suckDISCOMFORTS OF EARLY PREGNANCY

1. Breast Tenderness

2.Palmar Erythema (Palmar pruritus)

3. Constipation

4.Nausea, Vomiting & Pyrosis

5. Fatigue

6. Muscle Cramps

7. Hypotension

8. Varicosities

9. Hemorrhoids

10. Heart Palpitations

11. Frequency of Urination

12. Abdominal Discomfort

13. Leukorrhea


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14. Backache

15. Headache

16. Dyspnea

17. Ankle Edema

18. Braxton Hicks Contractions

DANGER SIGNS OF PREGNANCY

1. Vaginal Bleeding

2. Persistent Vomiting

3.Chills and Fever

4.Sudden Escape of Clear Fluid from the Vagina.

5.Abdominal or Chest Pain

6.Pregnancy-Induced Hypertension (PIH)

7.Increase or Decrease in Fetal Movement

HEALTH PROMOTION DURING PREGNANCY

A.Promoting Nutritional Health During Pregnancy

Nutrition is a state of well-being achieved by eating the right food in every meal

and the proper utilization of the nutrients by the body

Proper nutrition is eating a balanced diet in every meal. A balanced diet is made

upof a combination of the three basic food groups eaten in correct amounts. The

groupingserves as a guide in selecting and planning everyday meals for the

family.

Benefits of Proper Nutrition- It helps in the development of the brain, especially during the first years of the

child's life.

- It speeds up the growth and development of the body including the formation of

teeth and bones.

- It helps fight infection and diseases

- It speeds up the recovery of a sick person

- It makes people happy and productive

The Important Vitamins and Minerals are:1.PROTEIN will make the mothers body and baby grow.

Rich sources are fish, meat, beans, eggs and mild.

Protein requirement is increased by 30 grams, from 44 grams to 74 grams for

pregnant women.


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2.CALCIUM will keep gums and teeth healthy and help in the growth and

development of bones and hair.

Foods rich in calcium are milk, cheese, dilis and shellfish.

3.IODINE prevent goiter and promote proper mental and physical development

of the growing fetus.

Rich sources are seafoods like seaweeds, alamang fish, tahong, halaan, tulya

and iodized salt.

4.IRON prevent anemia and increase production of RBC.

Sources of iron are dried dilis, tulingan, alamang, seaweeds, tahong, liver,

internal organs and green leafy vegetables.

ANEMIA DURING PREGANCY (Nutritional Anemia)1. Iron Deficiency Anemia

Caused by insufficient intake food rich in iron especially during

pregnancy.

Increase requirement of iron during pregnancy

Signs and Symptoms:

i.Headache, dizziness and pallor

ii.Pica craving from non-substance food

-is being experience by pregnant women with severe anemia

Management:

a. Correction of IDA through diet by eating iron rich food like green leafy vegetable

and

liver.

b. Correct IDA through Fe supplement.

5.CARBOHYDRATES provide energy needed by the mother in her dailyactivities.

Food rich in carbohydrates are rice, corn, cassava, camote, bread and other

bakery products such as cakes, cookies and other kakainin.

Food rich in fats are butter, oil, margarine, lard and coconut milk.


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A pregnant woman requires an additional 300 kcal per day.

Eat enough carbohydrates rich foods to maintain the ideal weight increase

for certain trimester of pregnancy

Energy needs increased slightly during the first trimester, substantialincrease in

maternal tissue during second trimester, and the placentaand fetus grow a great

deal during the third trimester.

* Decrease intake of carbohydrates when there is:

a. Frequent vomiting

b.Swelling of legs

c.Abnormal rapid increase in weight

2. VITAMINS

a.Vitamins A rich foods will

Increase resistance against infection

Prevent blindness

Make hair and skin healthy

Prevent death from pneumonia, diarrhea and measles.

Vitamin A is increased 25% is needed to allow for storage in the fetus

as well as to maintain healthy eyes, skin, and blood tissue.

Sources of Vitamin A are:

o

Green leafy vegetables such as malunggay, sili, gabi,

kangkong, alugbati and others.

o

Yellow fruits and vegetables such as carrots, squash, mango,

ripe papaya and melon.

o

Liver, meat, poultry and eggs.

b.Vitamin C rich foods will


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Increase body resistance against common illness like cough and colds

Keep gums and teeth healthy

Good sources of vitamin C are guava, tomato, mango, pineapple,papaya,calamansi and other fruits and green leafy vegetables likemalunggay, camote

tops, pechay and kangkong

Vitamin E

Protection of cell structure especially RBC and it also aids in the

storage Vitamin A in the liver.

d. Vitamin D

Normal requirement is increase by 50% to 100% to facilitate and

maximize calcium and phosphorous absorption for skeletal

development of both the mother and the fetus.

e. Vitamin K

For normal clotting ability of blood

f. Vitamin B

For blood clotting

3. MINERALS

a.Calcium and Phosphorus for bone and teeth development

b.Magnesium for healthy bones, muscles, and blood tissue.

c.Iron to increase hemoglobin levels supply in the maternal tissue,

placenta and fetus.

d.Zinc essential for growth and enzymatic action

e.Iodine to prevent maternal goiter4.Drink at least eight (8) glasses of water per day

B. Exercise

-It is important to prevent circulatory stasis in the lower extremities.

-It offers a general feeling of well-being

Benefits


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1.Lowered cholesterol level

2.Reduced risk of osteoporosis

3.Increased energy level

4.Maintenance of health body weight

5.Decreased risk of heart disease

6.Increased self-esteem and well-being

7.Possible reduction in the rate of cesarean birth

Perineal and Abdominal Exercises

1. Tailor Sitting

- The woman should place one leg in front of the other.As she sitsin this position,

she should gently push on her knew until she feelsher perineum stretch

Purpose:Stretches the perineal muscles without occluding blood

supply to the lower legs.

2. Squatting

-The woman tend to squat on their tiptoes.For the pelvic muscles

to stretch, the woman must keep her feet flat on the floor.

Purpose:Useful in second-stage labor that it also stretches the

perineal muscles.

3. Kegel Exercises

-The woman tightens the muscle of the perineum.

Purpose:Helpful in the postpartum period, promotes perineal

healing, and help prevent stress incontinence in later life.

4.Abdominal Muscle Contractions

Can be done in a standing or lying position along with pelvicfloor contractions.The

woman merely tightens her abdominalmuscles, and then relaxes them.

Purpose:Help strengthen the abdominal muscles during

pregnancy and therefore help prevent constipation as

well as help restore abdominal tone after pregnancy.

5. Pelvic Rocking

-The woman arches her back, trying to lengthen or stretch herspine.She holds the

position for 1 minute, and then hollows herback.

Purpose:Helps relieve backache during pregnancy and early labor

by making the lumbar spine more flexible.

Health Teachings

1.Never exercise to a point of fatigue.

2.Always rise from the floor slowly to prevent orthostatic hypotension.


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3.To rise from the floor, roll over to the side first and then push up to avoid strain

on

the abdominal muscles.

4.For leg exercises, to prevent leg cramps, never point the toes (extend the heel).

5.To prevent muscle strain, do not attempt exercises that hyperextend the lower

back.

6.Do not hold your breath while exercising because this increases intra-abdominal

and intrauterine pressure.

7.Do not continue with exercises if any danger signal of pregnancy occurs.

8.Do not practice second-stage pushing.Pushing increases intrauterine pressure

and could rupture membranes

C.Tetanus Toxoid Immunization

-Tetanus can start from unclean instruments used during cord cutting and

improper cord treatment.Tetanus in the newborn can be prevented by givingTetanus

Toxoid (TT) injections to the mother.However, one injection is not enough.At least2

injections given one month apart will protect the baby.When a mother has

receiveda total of 5 injections, all the babies that she will deliver should have

been protected.The TT injections also protect the mother from tetanus.

*TETANUS TOXOID Immunization Schedule for Women

Note:

a.Give tetanus toxoid at the 6th or 7th month to woman who didnt have this

before

b.If the woman received DPT in infancy 3 or 3 dose of DPT during infancy, this

should be considered as TT1 and TT2. The succeeding dose will TT3 and so forth

POSTNATAL CARE

Care of the Mother after Delivery

A mother who has just given birth should:

1. Take a bath daily.

2. Gently massage the breasts towards the nipples to prevent or lessen breast

swelling


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and increase milk flow.

3. Get enough rest and do less heavy work.

4. Breastfeed right after birth.

5. Clean the breast with warm water before breastfeeding.

6. Eat healthy food to produce more breastmilk.

To Take Care of the New Born Baby:

1. Breastfeed the baby right after birth

2. Give sponge bath daily. After the cord drops off, give baths daily.

3. Keep the baby warm enough.

4. Protect the baby from flies and mosquitoes.

5. Keep the baby in the clean place.

6. Keep the baby from the sick persons.

7. Bring the baby to the Health Center for immunization against the 6 common

childhood diseases.

The baby's cord is a common site of infection.

To prevent the infection:

- Keep the baby's cord clean and dry.

- It is better to use a belly band but if the mother wants to use a thin cloth and be

sure

that it is loose enough to let air in.

- Baby diapers should not cover the navel so that the cord does not wet with urine

Breastfeeding

Exclusive breastfeeding of infants recommended for the first six months of

theirlives and breastfeeding with complementary foods thereafter. Breastfeeding

has manyphysical and psychological benefits for children and mother as well as

economicalbenefits for families and societies

The Benefits of Breastfeeding

To Infants

Provides a nutritional complete food for the young infant.

Strengthens the infants immune system, preventing many infections.

Safely rehydrates and provides essential nutrients to a sick child,

especially to those suffering from diarrheal diseases.

Reduces the infants exposure to infection.

Clean and has the right temperature.

Helps in child spacing. It is always ready for the baby and needs no


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preparation.

Safe more digestible than cows milk.

To Mother

Reduces a womans risk of excessive blood loss after birth.

Provides a natural method of delaying pregnancies.

Reduces the risk of ovarian and breast cancers and osteoporosis.

It helps stop bleeding after delivery.

Breastfeeding on demand helps the mother against another pregnancy.

It is good psychologically for both mother and child. It helps them to bond

together, become attached to each other and love one another better.

It is economical and convenient.

The Three Es of Breastfeeding

1. Exclusive Breastfeeding

It means that the baby should receive only breast milk for the first 4-6 months of

life. Breast mil already contains almost everything the baby needs.

2. Early Start

Breastfeeding should start immediately after birth until tolerated but needs to

besupplemented with food rich in iron. This is a good time for the baby to learn to

suck. Inmost cases, the real milk of the mother comes in on the second or third

day. Mothers

should be encouraged to let their babies suck even if the milk has not come out

yet

because as the baby sucks:

He gets the colostrums.

The milk will be stimulated to flow earlier.

The uterus will contract and return to shape.

3. Extended Breastfeeding

Breastfeeding can continue for as long as the mother feels comfortable doingit.However, the baby will need other foods in addition to breast milk upon

reaching the ageof 4-6 months. Breastfeeding should continue for another 12-18

months while the childgets more and more solid foods.

Proper Breastfeeding Procedures

1. Care of the breast


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Wash the breast with clean water or with a wet piece of cloth or cotton. Do notuse

soap or alcohol as this can cause irritation and dryness. In case the mother takes

abath daily, there is no need to clean her breast before every breastfeeding. Hold

the breastand use to it that the thumb is gently pressing the nipple.

2. Proper positioning

Here are the correct steps to follow in positioning the baby for breastfeeding.

a. Let the mother sit or lie somewhere comfortable so that she is relaxed. A low

seat is

usually best.

b. Show her how to hold the baby in her arms. The baby faces the breast while the

babys

stomach is against the mothers stomach.

c. Let the back of the babys shoulders rest on the mothers arm. The babys head

shouldbe free to bend back a little.

d. She should touch the babys cheek or the side of the babys mouth. This will

stimulate

the rooting reflex.

e. She should wait until the babys mouth is open and ready to start sucking.

f. The mother should hold and offer the whole breast. She should not pinch the

nipple or

areola.

g. She should aim the babys lower lip towards the base of the areola.

These are the signs that the baby is in good position for breastfeeding.

a.The babys whole body is close to the mother; the baby is facing the mother;

and

the stomach of the baby is touching the mothers stomach.

b.The babys mouth and chin are close to the breast.

c.The babys mouth is wide open.

d.More part of the areola is seen above the babys upper lip and less of it can be

seen below his/her lower lip.

e.The baby takes slow deep sucks.

f.The baby is relaxed and happy.

g.The mother does not feel pain on her nipple.

These are also signs that the baby is in a bad position while sucking. These are:


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a.The babys stomach is not touching the mothers stomach.

b.The babys mouth and chin are separated form the breast.

c.There is too much areola seen below the lower lip of the baby.

d.The baby takes many quick and small sucks.

e.The baby uses or refuses to suck because he/she does not get the milk.

f.The mother may feel pain on her nipple.

Practical advice: When advising pregnant mothers, it is necessary that you have

achecklist of things that are useful for her to know before she delivers. Advise the

mothers that:

Breast milk is the best food for their baby. The quality of the milk will

always be good regardless of their diet.

The size and shape of the breasts do not matter. Small breasts and large

breasts both produce perfect milk in sufficient quantity.

Breastfeeding need not spoil their figure. It should help them to lose

weight after their babies are born. If they wear a good bra or other supportwhile

they breastfeed, their breast will return to good shape after theywean their

babies.

Bottle feeding is dangerous because it causes much illness.

Let the baby suck soon after delivery it will help their milk to flow

freely.

Make one or two of their dresses open at the front so that youre their

babies can breastfeed easily.All mothers feel more emotional and sensitive than usual for a few weeks

after delivery.

Research for Sotto

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