PREGNANCY AND THE PRENATAL PERIOD

Diagnosis of Pregnancy

Presumptive Signs Least indicative of pregnancy Taken as single entities

Probable Signs Can be documented by examiner More reliable but still are not positive

Positive Signs Documented pregnancy

Presumptive Signs

Breast changesNauseaVomitingFrequent urinationFatigueUterine enlargementQuickeningLinea NigraMelasmaStriae gravidarum

Probable Signs

Lab test hCG detection – accurate on in 95-98% of the time

Measurable level (50mIU/ml) 7 to 9 days after conception

Home preg test Can detect as little as 35 mIU/ml of hCG

Probable Signs

Chadwick’s signGoodell’s signHegar’s signUTS findings of gestational sacBraxton Hicks contractionsFetal outline felt by examiner

Positive Signs

Demonstration of fetal heart separate from the mother’s

Fetal movements felt by an examinerVisualization of the fetus by ultrasound

Physiologic changes of Pregnancy

REPRODUCTIVE SYSTEMLength increases from 6.5 to 32cmDepth increases from 2.5 to 22 cmWidth expands from 4 to 24 cmWeight increases from 50 to 1000 gramsEarly in pregnancy, the uterine wall thickens from

about 1 to 2 cm; towards the end, the wall thins to become supple and 0.5 cm thick

Volume increases from 2 ml to more 1000 ml

Physiologic changes of Pregnancy

BREAST CHANGESBreast size increases bec of hyperplasia of the

mammary alveoli and fat depositsAreola darkens,diameter increases from 3.5 cm

to 5 or 7.5 cmSecondary areola forms – additional darkening of

the skin surrounding the areolaBy the 16th week, colostrum can be expelled from

the nipples

Physiologic changes of Pregnancy

INTEGUMENTARY CHANGESgravidarum – pink or reddish streaks due to rupture

and atrophy of small segments of the connective layer of the skin becomes silvery white after delivery

Diastasis – separation of the rectus muscleLinea nigra/ melasma – caused by inc in melanocyte

stimulating hormoneVascular spiders or telangiectases and palmar

erythema due to increase estrogen

Physiologic changes of Pregnancy

RESPIRATORY CHANGESMarked congestion or stufiness of the nasopharynx in

response to the inc estrogen levelsAs the uterus enlarges, pressure is put on the

diaphragm and on the lungs crowding of the chest cavity acute shortness of breath

No change in vital capacityResidual volume is decreased up to 20%Tidal volume is increased up to 30-40%Respiratory minute volume increased by 40%Expiratory reserve decreased by 20%

Physiologic changes of Pregnancy

CARDIOVASCULAR CHANGESCardiac output – 25-50% increaseBlood volume increases by 30-50% (4000 vs 5250

ml) occurs gradually beginning at the end of 1st tri and peaks at 28th to 32th week then remains high all throughout the 3rd tri

Increased iron need of 800 mgBlood pressure decreases in the 2nd tri and

increases again in the 3rd tri

Physiologic changes of Pregnancy

GASTROINTESTINAL CHANGESIncreasing HCG and progesterone – nausea and

vomiting but will subside after 3 monthsIncrease saliva formation because of estrogenAcidity of the stomach decreases chronic

gastric reflux improvedHyperthrophy of gumlines and bleeding of

gingival tissue

Physiologic changes of Pregnancy

URINARY CHANGES Changes result from:

effects of high estrogen and progesterone Compression of bladder and ureters by the growing uterus Increased blood volume Postural influences

To provide sufficient fluid volume for effective placental exchange, total body water increases to 7.5L

Fluid is retained to aid the inc in blood volume and to serve as ready source of fluid for the fetus

The glomerular filtration rate and renal plasma flow increases to meet the increased needs of circulatory system (increased to 30-50%)

Physiologic changes of Pregnancy

URINARY CHANGESIncreased levels of progesterone during

pregnancy, the ureters inc in diameter and bladder capacity increases to about 1500 ml

Increase in frequency of urinationUterus tends to rise on the right side of the

abdomen bec it is pushed slightly in that direction by the greater bulk of the sigmoid colon urinary stasis and pyelonephritis

Physiologic changes of Pregnancy

SKELETAL CHANGESGradual softening of pelvic ligaments and joints

to create pliability and to facilitate passage of the baby thru the pelvis due to ovarian hormone called relaxin and progesterone

Wide separation of symphisis pubis as much as 3-4 mm by 32 weeks AOG

Lordosis (forward curve of lumbar spine) may cause backache

Physiologic changes of Pregnancy

ENDOCRINE CHANGESThyroid gland – slight enlargement; inc thyroid

hormone productionParathyroid gland - slight enlargement; inc

parathyroid hormone productionPancreas – early: dec insulin production bec of heavy

fetal demand for glucose after 1st tri: inc insulin production bec of antagonist properties

of estrogen, progesterone, HPLPituitary gland – FSH,LH decrease, Prolactin

increases, Melanocyte stimulating hormone increase, growth hormone increase

Terms related to Pregnancy Status

Para - number of pregnancies that reached viability Gravida – woman who is or has been pregnantPrimipara – given birth to 1 child past the age of viability

Primigravida – pregnant for the 1st timeMultipara – has carried 2 or more pregnancies to

viabilityMultigravida- been pregnant previouslyNulligravida – never been and is not currently

pregnant

Prenatal check up

History: Personal/social/sexual history Mesntrual history Family history Past medical history Gynecologic history Obstetric history

Physical examinationInternal examinationDiagnostics examinations

Obstetric Scoring

Gravida Para GP TPAL TermPretermAbortionLivebirth

examples

DIAGNOSTICS

URINALYSISCBCBLOODTYPINGHEPA B ANTIGENVDRL/RPRPAPSMEARULTRASOUND50 GRAMS ORAL GLUCOSE CHALLENGE

TEST – 24-28 weeks