PREGNANCY

Reported by: Nolte L. Bombay, RN

Pregnancy
is the fertilization and development of

one or more offspring, known as an embryo or fetus, in a woman's uterus. there can be multiple gestations, as in the case of twins or triplets. Childbirth usually occurs about 38 weeks after conception

Pregnancy
Health promotion during pregnancy:
1. Tetanus Immunization:

TT1-During pregnancy TT2-4wks after TT1; 3-year protection TT3 6mos. After TT2; 5-year protection TT4 1year after TT3; 10-year protection TT5 1 year adter TT4; Lifetime protection

Pregnancy
Physical Examination:

(Cephalocaudally- from head to foot). Estimation of Gestational Age:

Naegeless Rule- used to determine

the expected date of delivery by determining the LMP of the mother. January-March +9+7 1-1-07 Jan. 1, 2007=10-8-07 Oct 8, 2007

Pregnancy
Pelvic Examination:
Papanicolau (PAP) Smear- cytological exam

to determine the presence of cancer cells

Leopolds Maneuver:
In obstetrics, Leopold's Maneuvers are a

common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.

Pregnancy: Physiological Changes

The Whole Period of Pregnancy

Can Be Divided Into Three Stages:

The first trimester (early pregnancy):1-

12wks The second trimester (middle pregnancy): 13-27 wks The third trimester (late pregnancy): 2840wks

Pregnancy
The Diagnosis of the First Trimester

1.History and symptoms

Cessation of menstruation This is the first

frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.

Pregnancy
Nausea and vomiting Also called morning

sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum). Urinary symptoms Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on

Pregnancy
Mastodynia It may be present in early

pregnancy and ranges in severity from a tingling sensation to frank pain.

2nd sign:
Breast enlargement and vascular

engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas (Montgomerys tubercles) may be noted.

Breast Changes

Pregnancy
Changes of the reproductive organs

Vagina:
The vaginal wall become discoloration as the

pelvic blood vessel becomes congested. Cervix: Cyanosis and a gradual softening due to congestion. Changes of the reproductive organs Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegars sign). After the 12th week, the fundus of the uterus is usually palpable above the

Hegars Sign

Pregnancy
Supplementary examination Pregnancy test :

The laboratory test for pregnancy are based

on the identification of human chorionic gonadotropin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine. Basal body temperature (BBT) A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

Pregnancy
Progesterone test:

Progesterone is given to a women with

amenorrhea. If she is pregnant, no bleeding will follow, otherwise, bleeding should occur within 7-10 days of progesterone administration. This is reliable in the non pregnant patient only if there is adequate estrogen stimulation of the endometrium.

Pregnancy
Ultrasonography There are trans-vaginal and

abdominal Ultrasonagraphys. A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period. Ultrasonography Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week. Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

Pregnancy
The diagnosis of the second and the third

trimester pregnancy Symptoms Abdominal enlargement and fetal movement generally occurs after the 18th to 20th week of gestation. Signs The uterus continues to enlarge Fetal movement (quickening) can usually be seen or heard after 18th week of gestation

Height of the uterine top xiphoid

Pregnancy
Signs Fetal heart sound can be heard at rate

varies from 120 to 160 beats per minute.

The fetal body can usually be palpated by the

18th to 20th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

Fetal heart

Pregnancy
Ballottement. This is demonstrated during the

bimanual exam at the 16th to 20th week. Ballottement is when the lower uterine segment or the cervix is tapped by the examiner's finger and left there, the fetus floats upward, then sinks back and a gentle tap is felt on the finger

Ballottement

High Risk Mothers

What causes a high-risk pregnancy?

Before a woman becomes pregnant, it is

important for her to have good nutrition and a healthy lifestyle. Good prenatal care and medical treatment during pregnancy can help prevent complications.But there are factors that can be present before a woman becomes pregnant, that can cause a high-risk pregnancy.

High Risk Mothers

Risk factors for a high-risk pregnancy

can include: Young or old maternal age 17-35 yrs old Being overweight or underweight Having had problems in previous pregnancies Pre-existing health conditions, such as high blood pressure, diabetes, or HIV

High Risk Mothers

What are some conditions that may cause a high-risk

pregnancy?
Preeclampsia and Eclampsia - Preeclampsia is a

syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mothers kidneys, liver, and brain. With treatment, many women will have healthy babies. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems. Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother.

High Risk Mothers

Gestational Diabetes Mellitus (or gestational

diabetes) is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes. Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.

High Risk Mothers

HIV/AIDS kills or damages cells of the body's

immune system, progressively destroying the body's ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection.Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding. But, there are effective ways to prevent the spread of mother-to-infant transmission of HIV.

High Risk Mothers

Preterm Labor: is labor that begins before 37

weeks of pregnancy. Because the baby is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time.Although there is no way to know which women will experience preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth.

High Risk Mothers

During pregnancy, there are also steps a

woman can take to reduce the risk of certain problems: Getting at least 400 micrograms of folic acid every day if she thinks she could become pregnant, and continuing folic acid when she does get pregnant Getting proper immunizations Maintaining a healthy weight and diet, getting regular physical activity, and avoiding smoking, alcohol, or drug use Starting prenatal care appointments early in pregnancy

Post Natal Care

Giving birth is both exhausting and

emotional. After the birth, you may feel very tired and with your hormones once again changing, very emotional. Physically, you may feel sore, especially if you have had stitches.

Post Natal Care

Keep eating a healthy diet

It is very important to maintain a healthy

diet. Not only do you need the energy in the short term to look after your baby, a healthy diet will have long term health benefits for you and your family. healthy meals like baked potatoes with a variety of fillings (e.g. tuna fish or baked beans).

Post Natal Care

Breastfeeding

A healthy diet is especially important if you

choose to breastfeed. Dont try and lose weight. Breastfeeding is demanding and trying to diet will make you feel even more tired. Breastfeeding uses up the fat stored during pregnancy so will help you lose weight and get your shape back naturally.

Post Natal Care

You are likely to feel very thirsty while you are

breastfeeding, particularly during the feed itself. Try to drink water rather than tea or coffee. You can now eat the foods you were advised to avoid during your pregnancy (e.g. cheeses and pate) because your baby is no longer in direct contact with your blood supply. However, whatever you eat and drink passes into your breast milk. Be aware that some foods and drinks may upset your baby and learn to avoid these if you can.

Post Natal Care

It is a good idea not to drink too much alcohol

and try not to drink before a feed. The current recommendation is no more than eight units a week and no more than two units in a day. (A unit = half pint of beer, lager or cider; one glass of wine). Caffeine may also make your baby irritable so keep intakes of tea, coffee and cola low. Try not to smoke as nicotine will pass into your babys bloodstream.

Post Natal Care

If you, your babys father or any previous

children have a history of hayfever, asthma, eczema or any other allergies, avoid eating peanuts and foods containing peanut products. It is important to check with your GP or pharmacist that any over-the-counter or prescribed medicines are safe to take while breastfeeding.

Post Natal Care

Exercise

If you are feeling tired, you probably wont feel

like exercising, but exercise can be relaxing, it will help your body recover, ensure you keep fit and will generally make you feel better. Check with one of your health care team before you start exercising after the birth. Walking is ideal.

Post Natal Care

Rest

Looking after a newborn baby is demanding.

Your body is also recovering from the rigours

of pregnancy and childbirth and if you are feeding through the night, you may become exhausted. It is essential that you rest.

Post Natal Care

Coping with changes

Your life really will change dramatically.

Try not to have unrealistic expectations of

yourself. There may be days when you wont manage to finish anything you started and days when you feel you cant cope. You will have to learn to compromise, especially if you are a perfectionist, otherwise you will wear yourself down. You simply wont have the time to do everything that you would like to do and will have to let things go a little.

Post Natal Care

Your emotions Changes in your hormone levels may make you

feel tearful, irritable, depressed and tired. Often, between three and five days after the birth you may feel particularly low and emotional. This time is referred to as the 'baby blues' and thought to be caused by sudden changes in your hormone levels. It should only last for a few days. Try to rest as much as you can, eat healthily and accept offers of help. If you often feel depressed and despondent over a period of weeks or months, it is important to talk to one of your health care team.