1. Prenatal Care (Pangangalaga sa Pagbubuntis) 🤰
Prenatal Visits Schedule
- 1st Trimester: Monthly visits (4-12 weeks)
- 2nd Trimester: Monthly visits (13-28 weeks)
- 3rd Trimester: Every 2 weeks (28-36 weeks), then weekly until delivery
- Minimum: 4 prenatal visits (WHO recommendation)
Initial Assessment
- Complete OB history (GTPAL: Gravida, Term, Preterm, Abortion, Living)
- Last Menstrual Period (LMP) - for EDD calculation
- Naegele's Rule: LMP + 7 days - 3 months + 1 year
- Physical exam, vital signs, baseline weight
Prenatal Laboratory Tests
- CBC, Blood typing (ABO & Rh), Urinalysis
- VDRL/RPR (Syphilis), HIV screening
- Hepatitis B surface antigen (HBsAg)
- Blood glucose screening (24-28 weeks for GDM)
2. Normal Pregnancy Changes ✨
Presumptive Signs (Subjective)
- Amenorrhea (missed period)
- Nausea/vomiting (morning sickness)
- Breast tenderness
- Urinary frequency
- Fatigue
Probable Signs (Objective)
- Positive pregnancy test (hCG)
- Uterine enlargement
- Hegar's sign (soft isthmus)
- Chadwick's sign (bluish cervix/vagina)
- Goodell's sign (soft cervix)
Positive Signs (Diagnostic)
- Fetal heart tones (FHT) - Normal: 120-160 bpm
- Fetal movement felt by examiner
- Visualization of fetus on ultrasound
3. Stages of Labor 👶
First Stage (Dilation)
From onset of true labor to full cervical dilation (10 cm)
- Latent Phase: 0-3 cm, slow dilation, mild contractions
- Active Phase: 4-7 cm, faster dilation (1 cm/hr primi, 1.5 cm/hr multi)
- Transition: 8-10 cm, most intense, patient may feel urge to push
Second Stage (Expulsion)
From full dilation to delivery of baby
- Duration: Up to 2 hours (primi), 1 hour (multi)
- Cardinal movements: Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion
Third Stage (Placental)
Delivery of placenta (5-30 minutes)
- Signs of separation: Uterus rises, gush of blood, cord lengthens
- Active management: Oxytocin, controlled cord traction, uterine massage
Fourth Stage (Recovery)
First 1-2 hours after delivery. Monitor for hemorrhage!
- Check uterine fundus (should be firm)
- Monitor vital signs every 15 minutes
- Check lochia (vaginal discharge)
4. High-Risk Pregnancy Conditions ⚠️
Pre-eclampsia / Eclampsia
- BP ≥140/90 after 20 weeks + proteinuria
- Eclampsia: Pre-eclampsia + seizures
- Treatment: Magnesium sulfate, delivery
Placenta Previa
- Placenta covers cervical os
- Painless, bright red bleeding
- NO internal exam! Cesarean delivery
Abruptio Placentae
- Premature placental separation
- Painful, dark red bleeding, rigid uterus
- Emergency! Fetal distress risk
Gestational Diabetes
- Screen at 24-28 weeks (OGTT)
- Risk of macrosomia, birth injuries
- Diet, exercise, insulin if needed
💡 Board Exam Tips - Obstetrics
- ✓ Remember GTPAL for obstetric history documentation
- ✓ Placenta Previa = Painless bleeding; Abruptio = Painful + rigid uterus
- ✓ MgSO4 for pre-eclampsia: Watch for toxicity (RR, reflexes, urine output)