PREGNANCY Reported by: Fatima-Nushaiba E. Abubakar SIGNS AND SYMPTOMS OF OVULATION a.

Abrupt slight rise in basal body temperature 0.3 to 0.5 C or 0.4 to 0.8 F b. Presence of mittelschmerz sensation of lower abdominal discomfort on the side of the ovary c. Identification of fertile cervical mucus o Clear and transparent o Slippery and lubricative o Stringy, elastic, and stretchable, and o Having positive Fern Test d. Positive Spinnbarkeit Test

CONCEPTION Fertilization usually occurs in the outer third of the fallopian tube High estrogen levels increases peristalsis in the tube to move zygote toward the uterus. It takes 3 days for the zygote to reach the uterine cavity An ovum is receptive to fertilization for only 24 48 hours after ovulation o Mature ovum has only an X chromosome; sperm carries either X or Y chromosome o XX (female); XY (male) Sex is determined at the moment of fertilization Sperm are viable for 24 72 hours after ejaculation Terminologies: Cellular Multiplication: Occurs as the zygote moves through the fallopian tube towards the uterus. Zygote rapidly divides into more cells. By the time it enters the uterus it is in the form of a solid ball of 12 16 called the morula. Implantation: Occurs about one week after fertilization when the embryo buries itself in the upper segment of the uterine lining Pregnancy: Period of time between conception and birth during which a fertilized ovum matures and grows in the uterus. 3 Trimesters of Equal Length 1st- Conception to 14 weeks 2nd- 14-28 weeks 3rd- 28-42 weeks Gestation: Length of pregnancy following conception; lasts approximately 280 days (40 weeks) Gravida: refers to a woman who is or has been pregnant Para: Indicates the number of pregnancies that reached viability (20 weeks) Primi: First Multi: More than one None: None or never

FETAL DEVELOPMENT A process by which the fertilized ovum grows into maturity as a newborn. There are three periods of fetal development: o Pre-embryonic period - fertilization thorugh the first 2 weeks o Embryonic period 3rd through 8th week - Most critical period, because all major organs are being developed - After 2 to 3 weeks of pregnancy, the blastocyst differentiates to 3 primary germ cell layers: Ectoderm: skin, nervous system, etc. Mesoderm: muscles, circulatory system, bones, reproductive system, connective tissues, etc. Endoderm: Alimentary and respiratory tracts, liver, bladder, and pancreas 8th week to the 40th week or birth

Fetal period

Fetal Circulation Ductus Venosus: Transports blood to the portal vein of the liver and the inferior vena cava Foramen Ovale: Shunts blood to the left atrium of the heart, moving to the left ventricle and the aorta. Ductus Arteriosus: Moves blood from the right ventricle to the pulmonary artery

CLINICAL MILESTONES 1. Early Prenatal care 2. Quickening 3. Auscultation of fetal heart tones 4. Fundic height 5. Ultrasound

ESTIMATING EXPECTED DATE OF DELIVERY (EDD): Naegeles Rule Date of LMP: Month -3 Day +7 Expected Date of Delivery Year +1

Mittendorfs Rule Formula:

For primigravid Caucasian women: [(LMP + 15 days) 3 months] = EDD For multigravid non-Caucasian women:

[(LMP + 10 days) 3 months] = EDD

ESTIMATING GESTATIONAL AGE Fundic Height: Symphysis pubis: 12 weeks Umbilicus: 20 weeks Xiphoid process: 36 weeks Department of Health prescribes in its Home-based Maternal Birth Record (HMBR) Fifth month gestation: 20 cm Sixth month gestation: 21 -24 cm Seventh month gestation: 25 28 cm Eight month gestation: 29 -30 cm Ninth month gestation: 30 34 cm McDonalds Rule FH (in cm) X 2 = Gestational age in Months 7

ESTIMATING FETAL LENGTH Haases Rule A. From 1 to 5 lunar months of pregnancy (Months of pregnancy)2 = Fetal Length

B. From 6 to 10 lunar months of pregnancy (Months of pregnancy) X 5 = Fetal Length

SIGNS OF PREGNANCY Presumptive Amenorrhea Nausea/Vomiting Probable Positive (Detected at about the 12th week) Pigmentation changeson abdomen Detection of fetal heart tones (linea nigra) and face (chloasma Palpation of fetal movement gravidarum)

Breast changesenlargement, tingling Chadwicks signpurplish tinge of Ultrasonic evidence of a fetus of breast, increased sensitivity to vulva and vagina touch, darkening of nipples and areola Hegars signsoftening of the lower Urinary frequency uterine segment Goodells signsoftening normally-firm cervix of Ballotementdetection floating in amniotic fluid of fetus

Braxton Hicks contractions irregular, painless uterine contractions Palpation of fetal outline Positive pregnancy test

NORMAL PHYSIOLOGICAL CHANGES OF PREGNANCY PLACENTAL HORMONES 1. Human chorionic gonadotropin (HCG) o Secreted by the trophoblastic cells during early pregnancy o Stimulates corpus luteum to produce progesterone and estrogen until placenta assumes function 2. Estrogen o Produced by the ovaries during menstrual cycles and by the corpus luteum in early pregancy o Placenta assumes production after after the 6th or 7th week. o Level remains high throughout pregnancy 3. Progesterone o Produced by corpus luteum and then by placenta o High level are found during pregnancy o Most important hormone of pregnancy o Maintains the endometrium and prevents abortion by relaxing uterine muscles. o Relaxes all smooth muscles 4. Human placental lactogen o Increases availability of glucose for the fetus. o Level increases steadily throughout pregnancy 5. Relaxin o Inhibits unterine activity o Softens connective tissue o Relaxes pelvic joints

PHYSIOLOGICAL CHANGES OF PREGNANCY

Human System Reproductive

Musculoskeletal

Cardiovascular

Respiratory

Gastrointestinal

Urinary

Endocrine

Changes Uterusenlarges; irregular, painless contraction occurs Ovariesovulation stops due to high levels of placental estrogen and progesterone Vaginabecomes softer, mucosa thicken, vascularity increases, vaginal discharge increases and becomes more acidic Breastsincrease in size and become full and tender; areola darken; colostrums is excreted Cervixsoftens (Goodells sign), becomes congested with blood (Chadwicks sign), proliferating glands from mucus plug Relaxation of joints Widening of symphysis pubis Wadding gait Lordosis Increased back strain Heart muscle enlarges Heart rotates upward and to the left Stroke volume increases Cardiac output increases Pulse rate increases by about 10 15 beats per minute Peripheral vascular resistance falls under the influence of progesterone and prostaglandins Femoral venous pressure increases BP remains essentially the same Blood volume increases to 1200-1600mL above pre-pregnant values Total red cell mass increases; however, the increase in plasma volume is even more pronounced, resulting in dilution of RBC mass and a decline in hematocrit (this is not true anemia) WBC count increases to an average of 10,000/mm3 Clotting factors increase, offering protection against bleeding, but increasing chance of thrombophlebitis Oxygen consumption increases by about 20% Dyspnea is common Nosebleeds and nasal stuffiness are common Rib cage widens Respiratory depth increases Gums appear red and swollen and bleed easier, caused by elevated levels of estrogen Nausea and vomiting Delayed gastric emptying and reduce tone of cardiac (esophageal) sphincter allows reflux of acidic stomach contents, producing heartburn Decreased motility in large intestine allows more water to be absorbed; may cause constipation and hemorrhoids Increased thirst and appetite Frequent urination is common, particularly in the 1st and 3rd trimesters Urinary stasis predisposes to urinary tract infections Renal blood flow increases Placenta becomes an endocrine organ and produces large amounts of estrogen, progesterone, and glucocorticoids After first trimester, the pancreas produces additional insulin; however by the end of the pregnancy, tissue sensitivity to insulin falls by up to 80% Oxytocin and prolactin are secreted by the pituitary gland Thyroid gland enlarges; basal metabolic rate increases

NUTRITION

During Pregnancy Increase daily intake of minerals, and protein. Meat, fish, eggs, poultry, beans, legumes, seeds, nuts, milk, and cheese supply protein. An additional 300 calories a day are required 70 to 80 grams per day of protein (or an addition of 30 g to the normal daily requirement) Daily quota of 90 g fat coming from animal sources Increase major minerals o Iron 30 to 60 mg per day taken regularly (18mg per day for non-pregnant women o Calcium and Phosphorus 1,200 mg per day (for each mineral; more than 400 mg than non-pregnant women which is about 800 mg) o Iodine 175 micrograms/day; lactating mothers 200 micrograms/day o Zinc Recommended Daily Allowance of 20 mg. Increase essential vitamins o Vitamin C 80 to 100 mg daily o Folic Acid/folate 400 800 micrograms per day o Vitamin B12 4 micrograms daily is recommended Emphasize the number of daily servings of essential foods o Protein rich food: 4 servings o Milk and dairy products: 4 servings o Grain and grain products: 4 servings o Fruits and vegetables: 4 servings, divided into 2 servings of green, leafy vegetables 1serving of vitamin C-rich fruit or vegetable; and 1 serving of other fruit or vegetable, as desired

Weight Gain Pattern for Pregnant Women With Ideal Body Weight at Conception 1. 2. 3. 4. First trimester Second trimester Third trimester Total weight gain : 1 lb per month ;3-4 lbs total : 0.9 to 1 lb per week; 10-12 lbs total : 0.5 to 1 lb per week; 8-11 lbs total : 25-30 lbs PRE-PREGNANT BMI Underweight (BMI <19.8) Normal (BMI 19.8 26) Overweight (BMI 26.1 29) Obese (BMI > 29) Twin gestation Weight Gain Distribution ORGANS/PARTS WEIGHT Fetus, placenta, and amniotic fluid 5.0 kg (11 lbs) Uterus 0.9 kg (2 lbs) Blood volume increase 1.8 kg (4 lbs) Maternal stores 2.3 4.5 kg (5 to 10 lbs) Breasts 1.4 kg (3 lbs) Total Gain: 11-13 kg (25-30 lbs) for women with IBW at conception TOTAL WEIGHT GAIN 28-40 lbs 25-35 lbs 15-25 lbs <15 lbs 35-45 lbs