??? ?? : ? ??? ???? ??????? ??? ??? ??? ?? ? ????? ?? ??? ??? ??? ??, ?? ? ??? ???? ???? ????? ????(family centered)? ????(women centered) ?????? ????? ???? ???? ????.

1
????? ??
????? ????
???/??? ??
2
???????? ?? ? ??

• ?? ? ??

3
1. ??

• ??? ?? ???? ?????? ?? ??? ??? ?? ??, ??, ????
  ?? ??? ???? ????? ??? ?? ??, ??, ?????? ??? ??
  ????? ?? ???.
• ??? ?? ? ??? ???? ??????? ??? ??? ??? ?? ?
  ????? ?? ??? ??? ??? ??, ?? ? ??? ???? ???? ?????
  ????(family centered)? ????(women centered)
  ?????? ????? ???? ???? ????.

4
??
1. ??? ? ??? ???? ????, ?????, ??? ? ????
??? ?? ??? ????. 2. ??? ?????? ????? ????
?????? ?? ???? ??? ????? ??? ????. 3. ???
??? ??? ???? ???? ???? ?????? ??? ????? ????
??? ????? ??? ????? ???? ???? ??? ??
??. 4. ???????? ??? ??? ??? ???? ??? ??
????? ???, ???, ???, ???, ????, ??.??? ???
??.
5
??????(Family-centered care)
??
1. ??????? ????? ???? ???? ?? ??? ????? ?????
??? ???? ???. 2, ???? ??? ??? ??? ???? ????
??? ??.??? ??? ?????. 3. ?????? ??? ??? ??? ???
?? ?? ?? ??? ???? ??? ??? ??? ???
????. 4. ???????? ????? ??? ???? ??, ??? ???
??, ????? ?? ? ??? ??, ????? ?? ?? ??? ??,
??? ??, ?? ???? ????, ????, ???? ?? ????.
6
??

• ??? ??? ??? ???? ??? ?????
• ??? ??? ??? ?? ??? ??? ???.
• ??? ?????? ????? ??? ????.
• ??? ??? ???? ??? ????. ??? ???
• ??? ?? ?????? ???? ????? ?????.

7
??????(Women-centered care)
??

• 1. ??? ? ??? ???? ??? ???? ??? ???? ??? ???? ???
  ????? ????.
• 2. ??? ????? ??? ???? ??? ??? ???? ?? ????? ???
  ???? ?????? ??? ????? ?? ??? ???? ??? ? ?? ??
  ???.
• 3. ??? ??? ?? ????? ?? ??? ??? ??? ??? ?? ??? ??.
• 4. ??? ??? ????? ??? ????? ???? ??? ??? ??? ???
  ??.
• 5. ???? ??? ???? ???? ???? ??? ??? ?????? ????
  ??? ??? ? ?? ??? ?? ??.

8
?????? ??????
1. 1950? ???? ??? ???? ???? ???? ?? ?? ? 2,
???? ??? ?? ?? ???? ???? ????? ???? ?? ???
??? 3. ???? ??? 1960??? ?? Lamaze
International? International Childbirth
Education Association? ?? ??? 4. ????? ?? ????
???? ??? ???? ??? ??? ??? ??? ??? ????
????? ?? ??? ???? 5. ????? 1990?? ???? ?? ? ?????
??, ??? ????, ??? ??? ?? ??? ??? ???
????? ?? ??? ???
9
????? ??

• 1. ????(perinatology)? ????(neonatology)? ??
• ??? ? ? ?? ??? ?? ??? ?? ?? ??
• ??? ? ? ?? ???? ?? ??? ??
• 2. ????? ??
• ?? ?? ??
• ????-??-??(LDR) ?? ????-??-??-??(LDRP)
• ? ? ??? ? ? ??? ??, ?? ??(rooming-in)? ???? ?.
• ???? ??? ?? ?? ??? ? ??.
• ????? ??
• ? ?(sitting), ???(semisitting) ?? ??(standing)
• ?????(kneeling), ???? ???(squating)
• ?? ??? ???(lying) ???? ?
• ???? ??? ???? ??? ???? ???.

10
?????? ????

• ???????(The clinical nurse specialist)
• ?????????(The womens health nurse
• practitioner)
• ?????(Certified nurse midwife) - ???
• ????? ????? ???? ?????? ?? ??
• ????? ?? ??? ????? ?? ???? ?
• ?????? ???? ??????? ???

11
????? ? ??? ??
1. ?? ?? ?? ??, ????? ??? ? ?? ?? ?? ? ?? 2.
??, ?? ??? ??? ?? ??? ?? 3. ??? ??? ??, ???
?? 4. ?? ??? ?? ???? 5. ? ??, ?? ?? ?? 6. ???
??? ??? ???? ?? ??? 7. ?? ??? ???? ??? ??? ????
?? ???
12
???? ????
1. ??? ???? ?? 2. ??? ???? ?? 1? ?????, 2?
????, 3? ????, 4? ? 3. 10? ??? ??? 4. ???? 5.
?? ?? ??? ?????? 6. ????? ???? 7. ??? ???? 8.
??? ???? ?? ?????? ?? ???
13
2. ???????? ???? ??
???? ??
??? ?? ??? ??? ? ??(??)? ??? ??.
??? ??? ???? ????? ????. ??? ???
????? ????? ?? ??? ??? ???, ??? ???? ???
????. ??? ??? ???? ?? ??? ??? ??.

• ??????? ????, 2? ??, ??? ??? ??

• ???? ?? ?????? ??????? ??? ???
• ????

14
???? ???? ??? ?? ??? ??? ????? ???? ??, ??
??? ??
????? ????(role behavior)
????(role transition) ?? ??, ?? ??,
?? ??, ?? ???
???? ??? ??(development crisis) ???
??(situational crisis) ??? ?? ??
15
???? ??? ?? ???? ?? ??? ? ?? ??? ??? ??

• ??(acquaintance) ?? ??? ?? ?,
• ????? ?
  ?? ??
• 2. ??(attachment) Klaus Kennel? ?? ?? ??
• 3. ??(bonding) ???? ??? ?? ????
• ??? ??
• 4. ?? ??? ????

16
????

• ??? ??? ?? ???(ovum), ??(embryo), ??(fdtus)

• ??(fertilization or conception)
• - ??? ??? ??? ?????
• - ??? ?? ??? ??,
• ????,
• 12-14??? ??? ????

Blastocyst - Trophoblast(cytotrophoblast,sy
ncytiotrophoblast) - Inner cell mass
Chorionic villi HCG
2. ??(implantation) - ????(implantation
bleeding)
17
3. ??? ?? 1) ???(decidua) - decidua
basalis(?????) - decidua capsularis(?????)
- decidua vera(?????) 2) ??(fetal
membranes) - amnion(??), amniotic
fluid(??) - chorion(??) chorionic laeve
chorion 3) ??(placenta) chorionic frondosum
placenta (1) ??? ?? ???, ??? (2)
??? ???? 2 artery, 1vein
Intervillous space(????) (3) ???
?? ???, ????, ??, ???? (4) ??? ????
????, ??? ??,
?? ????, ??
18
4) ?? ??? ?? ??? ??
??? ??? ?? ?????(hydroamnios),
?????(oligohydramnios)
5) ?? 2artery, 1vein Whartons
jelley
4. ??? ?? Ectoderm(???)
Mesoderm(???) Endoderm(???)
????
19
??? ?? ??? ??

• ??? ??
• 1) ??
• 2) ??? ??
• 3) ??
• 4) ?? ?? ?????? ??, ?????? ??
• 5) ?? 12?, 22-24?, 36?, 40?
• ???? ??
• Lightening(???)
• ????
• 6) ???? uterine souffle, funic souffle, FHR
• 7) ????? ??
• 8) Hegars sign
• 9) Goodells sign
• 10) Mucous plug show
• 11) Braxton-Hicks contraction
• 12) Ballottment 13) Quickening

20
2. Vagina? ?? 1) Estrogen progesterone? ??
2) Chadwicks sign 3) Leukorrhea increased 40
pH? ??
3. Ovary Followpian tubes 1) Estrogen
progesterone? ?? ??? ???? ?? 2) Corpus
luteum? ??? ??
4. Breast 1) increase in size firmness 2)
secondary areola(?2? ??) 3) Montgomerys
tubules 4) striae gravidarum(???) 5)
enlargement and prominence of superficial veins
6) nipple more prominent 7) 4-5???
??(colostrum) ??
21
? ??? ??

• Cardiovascular system
• 1) heart vessels
• a) ????? heart rate 10-15bpm ??
• b) BP constant
• c) ???? ????? ??? ??? ?? ?? ??
• d) ???? ???? ??? ?? ???? ??
• 2) blood volume
• a) 32-34?? ????? 25-40 ??
• b) hemodilution ??? ??
• c) Hg
• d) WBC averaged ????? ??, ??? ??
• 3) ???? 32?? 30-50 ??
• 4) Palpitation ????? ??? ???
• 5) Coagulation factors ??

22
2. Respiratory system 1) Diaphragm ??
dyspnea 2) Thoracic cage upward widens 3)
Tidal volume respiratory minute ??
respiratory alkalosis 4) Vascularization
increased nasal stuffiness, nosebleed,
voice changes,

eustachian tube blockage 5) Basal metabolism
rate 15-20 ?? - ????
3. Renal system 1) dilation of ureters
-right-urinary stasis 2) Bladder tone ?? 3)
???? ?? ??, ?? 4) ??? ???? ?? 50 5) ????
?? ?? ?? 6) sugar? ?? renal threshold ??
23
4. Integumentary system 1) Chloasm 2nd
trimester 2) Linea nigra 3) Strae gravidarum
5. Musculoskeletal system 1) wadding gait 2)
lumbosacral curve 3) mid lower spine ligament
muscle stress 4) backache leg cramps 5)
pelvic joint relax mobility increased 6)
rectus abdominal muscle
24
6. Gastrointestinal system 1) ??? ??? ?? ??
2) delayed emptying time of stomach reflux of
food 3) upward displacement compression of
stomach 4) displacement of intestine 5)
common problems a) nausea vomiting(morning
sickness) b) pica or food cravings c)
constipation d) hemorrhoids 6) ptyalism
7. Endocrine system 1) thyroid gland 2)
parathyfoid gland 3) pancreas 4)
pituitary prolactin
25
????
1. ????
1) ?????? . ???? ??(biological test) . ????
??(immunological test) . ???????
??(radio-immunological test) 2) ??? ???
??(presumptive signs) 3) ??? ??? ??(probable
signs) 4) ??? ??? ??(positive signs)
26
2. ????? ?? . 1st trimester(????) ?? 1?
13?(3??) . 2nd trimester(????) ??
14?-27?(4-6??) . 3rd trimester(????) ??
28?-40?(7-10??) ? ??? ?? ???? ???, ??? ??? ???
???
3. ??? ? ???? 1) ???? 2) ??? ???? ??, ???,
??, ????, ????? Nageles
rule, ??? 3) ???? ??, ?? ? ??, ??? ??? ??,
??? ??? ??(Leopold maneuver),
??????(HOF-height of fundus)
??????, ????, ?????
27
4. ? ???? . ?? 28??? ? ?? 1? . ??
36??? 2?? 1? . ???? 1?? 1?
5. ? ?? ????
28
??? ????

• ????(amniocentesis)
• ?? ???(14-20?) ??? ??, ??? ?? ??
• ???? ??? ? ???, ?? ?? ???? ??
• - ?? ? ?? ? ??
• - ? ??? ??
• 1) L/S ratio
• 2) Phosphatidylglycerol(PG)
• 2. ?? ?? ?? ??
• 1) NST ?? ???? ?? ?? ??? ??
• 2) CST ????-??????-????? ??
• -????? ??? ?? ??

29
????

• ?????
• ?????(FMCs, fetal movement count)
• NST
• ?? ?? ?? ??
• ??? ???? ????
• ?? ??
• ?? ????? ??
• ?? ??? ??
• 5. ???

30
????? ??

• ??????
• (1) ?? ??????
• ? Tocotransducer ????? ??? ?? ??
• (??? ??? ??? ?? ??)
• ? ??? transducer FHR ?? ??
• (2) ?? ??????
• ? ?? ? ?? transducer ????? ?? ??
• ?? ? ?? ??
• ? Cardiotachometer ???? spiral electrode ??

31
2) ???? ??? ?? ? ?? ???? ?? ? ????
- ?? ? ??? - ???? ?? ?? ?????
- ?? ???, ????? ??? ???? ?? ? ???? -
?? ???? - Ritodrine, terbutaline? ?? ??
- ????? ?? ????, ?? - ?? ????????
32

• ? ???? ??
• long-term variability(FHR? ???? ??, ?? 3-10?)
• Short-term variability(??? ???? FHR ??)
• ? ??? ???? ?? ??? ??? long-term variability
• ? FHR ???? ??
• - early deceleration
• - late deceleration
• - variable deceleration

2) ?????? pH? ???? ?? ???? ???? ?? ??
pH(7.25-7.35) ? ??? pH(7.20 ??) ?????
???? ??
33
3) ?????? ?? ? 15? ??? ??? FHR acceleration?
???? ????? ??? - ??? ?? ? - ?? ???
4) ????? ?? ??? ?? ?? ?? ??(5cc)
5) ???? ?? ?? ????? pH? ???? ?????? ?? pH?
7.20???? ??????? ????.
34
????
????? ?? 1) ? ?? ?? ?? ? ?? 2) ??? ?????
??? ??? ??? ??? ?? 3) ?? ? ??? ???? ??????
?? ? ??? ?? ? ??? ?? ?? 1) ??
2) ?? ?? 3) ???? ?? 4) ???? ?? 5) ??
6) ?? 7) ?? 8) ?? 9)
??? 10) ?? 11) ???? 12) ??? 13)
??
35

• ?? ??????? ???? ?? ??? ??
• (Danger signs)
• ?. ???
• ?. ???
• ?. ????
• ?. ??
• ?. ??? ??? ??
• ?. ??? ?? ? ??

• ??? ??? ?? ??
• ?. ??
• ?. ???? ????
• ?. ???? ??? ??

36

• ??? ??? ???? ?? ????
• 1) ??
• 2) ???
• 3) ??
• 4) ??? ???
• 5) ??? ??
• 6) ??? ??
• ?. ??
• ?. ???? ??
• 7) ????
• 8) ????
• 9) ??
• 10) ???? ??
• 11) ? ??? ? ??

37
????
??? ????? ??? ? ?????? ??? ????? ???? ????? ???
?? ????.
????? ?? ??? ???? ??? ?? ?? ????. ???? ????? ????
????? ???, ??? ??? ????? ????. ???? ????, ??,
??, ??? ???, ???? ??? ?? ?????,
??? ?? ????? ??
???? ???? ??? ???
???
??? ??
38
?? ? ???? ?? 10? 650g, ?? 20? 4,000g
?? 30? 8,500g ?? 40? 12,500g
?? ??, ?? ?? ???? ? ?? 0.5kg ? ?? 0.3kg ??
?? 0.4kg
??? ????
??
39
Psychosocial changes

• Factors influencing a womans response to
  pregnancy
• a) memories of her own childhood
• b) cultural background
• c) existing support system
• d) socioeconomic conditions
• e) perceptions of maternal role
• f) impact of mass media

40
2. Maternal adaptation to pregnancy 1) 1st
trimester ambivalence, focus upon self 2)
2nd trimester awareness interest in fetus
acceptance of reality of
pregnancy feeling of
well0being 3) 3rd trimester anticipation of
labor delivery
introversion viewing
infant as reality vs fantasy
fears fantasies
nesting behaviors
41
3. Psychological tasks of pregnancy(Rubin,
1961) 1) 1st trimester acceptance of
pregnancy as a reality
incorporation of fetus into body image 2) 2nd
trimester preparation for physical separation
from fetus 3) 3rd
trimester attainment of maternal role
42
4. Paternal reactions to pregnancy 1) 1st
trimester ambivalence anxiety about role
change 2) 2nd trimester increased confidence
interest in mothers
care difficulty relating
to fetus jealousy 3) 3rd trimester
changing self concept
fear about mutilation/death of fetus
5. Sibling reaction to pregnancy 1) normal
rivalry dependent on developmental stage 2) may
need increased affection attention 3)
regressions in behavior(bed-wetting thumb
sucking)