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Lesson 455 min read
Maternal & Child Health
Pregnancy, Labor & Delivery, Newborn Care & Pediatric Nursing
Fetal Development Milestones
| Week | Development | Clinical Significance |
|---|---|---|
| 4 weeks | Heart begins to beat | Critical period for heart defects |
| 8 weeks | All organs present, embryo becomes fetus | End of embryonic period |
| 12 weeks | Sex distinguishable, FHT by Doppler | Genetic testing possible |
| 16-20 weeks | Quickening (mother feels movement) | Amniocentesis can be done |
| 24 weeks | Viability (can survive with support) | Age of viability |
| 28 weeks | Eyes open, surfactant production | Less risk of RDS |
| 40 weeks | Full term | Expected delivery date |
APGAR Score
Assessed at 1 minute and 5 minutes after birth
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| A - Appearance (Color) | Blue/pale all over | Body pink, extremities blue | Completely pink |
| P - Pulse | Absent | <100 bpm | >100 bpm |
| G - Grimace (Reflex) | No response | Grimace | Cry, cough, sneeze |
| A - Activity (Tone) | Limp | Some flexion | Active movement |
| R - Respiration | Absent | Slow, irregular | Good, crying |
Interpretation
7-10: Normal4-6: Needs assistance0-3: Immediate resuscitation
Stages of Labor
Stage 1: Cervical Dilation (Longest)
- Latent Phase: 0-3 cm, mild contractions, may last 8-10 hrs (nullipara)
- Active Phase: 4-7 cm, stronger contractions every 3-5 min
- Transition Phase: 8-10 cm, intense contractions, urge to push
Stage 2: Expulsion
From complete dilation to delivery of baby. Mother pushes with contractions. Duration: 30 min - 2 hrs.
Stage 3: Placental Delivery
Delivery of placenta. Usually 5-30 minutes. Signs: gush of blood, cord lengthening, uterus rises.
Stage 4: Recovery
First 1-2 hours after delivery. Monitor for hemorrhage (boggy uterus). Check fundus, lochia, vital signs q15min.
Newborn Assessment
Normal Newborn Vital Signs
- Heart Rate: 120-160 bpm
- Respiratory: 30-60/min
- Temperature: 36.5-37.5°C
- Weight: 2,500-4,000g (5.5-8.8 lbs)
Newborn Reflexes
- Moro: Startle reflex (disappears 4-6 mo)
- Rooting: Turn toward touch on cheek
- Sucking: Suck when object in mouth
- Grasp: Grip finger placed in palm
- Babinski: Toes fan out when sole stroked
Immediate Newborn Care
- Dry and stimulate
- Clear airway if needed
- Clamp and cut cord
- Assess APGAR at 1 and 5 minutes
- Eye prophylaxis (erythromycin)
- Vitamin K injection (prevent bleeding)
- Maintain warmth (skin-to-skin)
- Initiate breastfeeding within 1 hour
Philippine Immunization Schedule
| Age | Vaccine |
|---|---|
| At birth | BCG, Hepatitis B (HB1) |
| 6 weeks | Pentavalent (DPT-HepB-Hib) 1, OPV 1, PCV 1 |
| 10 weeks | Pentavalent 2, OPV 2, PCV 2 |
| 14 weeks | Pentavalent 3, OPV 3, PCV 3, IPV |
| 9 months | MMR 1 |
| 12 months | MMR 2 |