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SIGNS OF PREGNANCY

Signs of Pregnancy
Presumptive signs- subjective findings
Felt by the woman Signs that may indicate other conditions

Probable signs- objective findings


Observed by the examiner

Positive signs- findings that can be observed by the mother and the examiner
Confirmatory diagnosis of pregnancy

Presumptive Signs

Probable Signs

Positive Signs

SYSTEMIC CHANGES DURING PREGNANCY

Reproductive System
UTERUS
Length, width, depth, weight, and volume increases Uterine wall thickens from 1cm to 2cms but by the end of pregnancy, it thins to only about 0.5 cm

CERVIX
Becomes vascular and edematous Presence of mucous plug, operculum

Reproductive System
VAGINA
Epithelium and underlying tissue becomes hypertrophic and enriched with glycogen Vaginal secretions fall becoming more acidic

Respiratory System
Shortness of breathing is common Marked congestion or stuffiness

Cardiovascular System
0-50% increase in the total cardiac volume Physiologic Anemia of pregnancy Leukocytes and Fibrinogen increases Supine Hypotension Syndrome Edema and varicosities of the lower extremities

Gastrointestinal System
Slow emptying time of the stomach Hypertyalism Decreased pH of the saliva

Urinary System
GFR increases BUN and Plasma Creatinine decreases Renal threshold for sugar decreases Frequent urination in 1st trimester, normalizes in 2nd trimester, fequent urination in 3rd trimester

Musculoskeletalskeletal System
Calcium and Phosphorus needs are increased Gradual softening of the pelvic ligaments Wide separation of the symphysis pubis Pride of Pregnancy

Immune System
IgG production decreases WBC simultaneously increases

Endocrine System
Increased thyroid and parathyroid hormone production Insulin production is decreased early during pregnancy and increases after the 1st trimester Prolactin, Melanocyte-stimulating hormone, and human growth hormone of the pituitary gland increase Placenta as a transient endocrine organ

PSYCHOLOGICAL CHANGES DURING PREGNANCY

PSYCHOLOGICAL CHANGES DURING PREGNANCY


1ST TRIMESTER
Task: Accepting the pregnancy

2ND TRIMESTER
Task: Accepting the baby

3RD TRIMESTER
Task: Preparing for the baby and end of pregnancy

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DISCOMFORTS OF PREGNANCY

1ST TRIMESTER Discomforts


Breast tenderness Palmar erythema / pruritus Constipation Nausea and vomiting Pyrosis / heartburn Fatigue Leg cramps Supine hypotension

Orthostatic hypotension Varicosities Hemorrhoids Heart palpitations Frequency in urination Abdominal discomfort Round ligament pain Leukorrhea

2ND and 3RD TRIMESTER Discomforts


Backache Dyspnea Ankle edema Braxton hicks contractions

DANGER SIGNS OF PREGNANCY

DANGER SIGNS OF PREGNANCY


Vaginal bleeding Hyperemesis gravidarum Chills and fever Sudden escape of fluid from the vagina Abdominal pain Chest pain Pregnancy-induced hypertension Increase or decrease in fetal movement

PRENATAL CARE
Pre-consultation Phase Consultation Phase Post-consultation Phase

PRE-CONSULTATION PHASE
HEALTH HISTORY OBSTETRICAL DATA
Pregnancy Status Primigravida Multigravida OB Score GTPALM

Primipara Multipara

Nulligravida

PRE-CONSULTATION PHASE
IMPORTANT ESTIMATES
Naegles rule Mc Donalds method Bartholomews rule Haases rule Johnsons rule

CONSULTATION PHASE
PHYSICAL EXAMINATION PELVIC EXAMINATIONS
External Genitalia Examination Internal Examination Bimanual Examination Rectovaginal examination Papanicolaou Smear

LEOPOLDS MANEUVER LABORATORY STUDIES

DIANNA S. GERONA, RN

31

Pap Smear Classifications


CLASSIFICATION Class I
Class II Class III Class IV Class V

INTERPRETATION Normal cytology


Atypical cytology but no evidence of malignancy Cytology suggestive of malignancy Cytology strongly suggest malignancy Invasive Cancer
DIANNA S. GERONA, RN 33

Clinical Stages for Localization of Malignant Cervical Changes


STAGE Stage I Stage II LOCALIZATION CA confined in the cervix CA extends beyond the cervix into the vagina, but not into the pelvic wall or lower 1/3 of the vagina

Stage III Metastasis to the pelvic wall

Stage IV Metastasis beyond the pelvic wall into the bladder and rectum
DIANNA S. GERONA, RN 34

LEOPOLDS MANEUVER
A systematic method of observation and palpation to determine the presentation, fetal position, attitude, fetal lie, and degree of engagement. Preparatory Steps:
Instruct to void Position the patient Palpate with warm hands

First Maneuver
Palpation of the Uterine Fundus

MARY LOURDES NACEL G. CELESTE, RN, MD

36

Second Maneuver Determines small parts and back of fetus along the sides of maternal abdomen

MARY LOURDES NACEL G. CELESTE, RN, MD

37

Third Maneuver (Lower uterine segment or uterine pole)

MARY LOURDES NACEL G. CELESTE, RN, MD

38

Fourth Maneuver (pelvic palpation of the uterus - assess the presenting part)

MARY LOURDES NACEL G. CELESTE, RN, MD

39

DIANNA S. GERONA, RN

40

LABORATORY STUDIES
Blood Studies
CBC Blood typing and Rh factor Serologic test for syphilis / gonorrhea

Urine Examination
Heat and Acetic acid test Benedicts test Urinalysis

POST-CONSULTATION Health Teachings


Nutrition Bathing Dental care Breast care Perineal hygiene Dressing

Medications Smoking Drinking Work Travel Sexual Activity

POST-CONSULTATION Health Teachings


Exercises

Tailor Sitting

POST-CONSULTATION Health Teachings


Exercises

Pelvic Rock

POST-CONSULTATION Health Teachings


Exercises

Squatting Kegel Exercise Modified Knee-Chest Shoulder Circling Walking

POST-CONSULTATION Health Teachings


Childbirth Preparation Methods
Bradley Method Dick-Read Method Lamaze Method

Tetanus Immunization Clinic Appointments