pregnancy changes

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  • PREGNANCY AND THE PRENATAL PERIOD

  • Diagnosis of PregnancyPresumptive Signs Least indicative of pregnancyTaken as single entitiesProbable SignsCan be documented by examinerMore reliable but still are not positivePositive SignsDocumented pregnancy

  • Presumptive Signs Breast changesNauseaVomitingFrequent urinationFatigueUterine enlargementQuickeningLinea NigraMelasmaStriae gravidarum

  • Probable SignsLab testhCG detection accurate on in 95-98% of the timeMeasurable level (50mIU/ml) 7 to 9 days after conceptionHome preg testCan detect as little as 35 mIU/ml of hCG

  • Probable SignsChadwicks signGoodells signHegars signUTS findings of gestational sacBraxton Hicks contractionsFetal outline felt by examiner

  • Positive SignsDemonstration of fetal heart separate from the mothersFetal movements felt by an examinerVisualization of the fetus by ultrasound

  • Physiologic changes of PregnancyREPRODUCTIVE 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 thickVolume increases from 2 ml to more 1000 ml

  • Physiologic changes of PregnancyBREAST 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 PregnancyINTEGUMENTARY CHANGESgravidarum pink or reddish streaks due to rupture and atrophy of small segments of the connective layer of the skin becomes silvery white after deliveryDiastasis 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 PregnancyRESPIRATORY 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 breathNo 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 PregnancyCARDIOVASCULAR 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 triIncreased iron need of 800 mgBlood pressure decreases in the 2nd tri and increases again in the 3rd tri

  • Physiologic changes of PregnancyGASTROINTESTINAL 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 PregnancyURINARY CHANGESChanges result from: effects of high estrogen and progesteroneCompression of bladder and ureters by the growing uterusIncreased blood volumePostural influencesTo provide sufficient fluid volume for effective placental exchange, total body water increases to 7.5LFluid is retained to aid the inc in blood volume and to serve as ready source of fluid for the fetusThe glomerular filtration rate and renal plasma flow increases to meet the increased needs of circulatory system (increased to 30-50%)

  • Physiologic changes of PregnancyURINARY CHANGESIncreased levels of progesterone during pregnancy, the ureters inc in diameter and bladder capacity increases to about 1500 mlIncrease 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 PregnancySKELETAL 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 progesteroneWide separation of symphisis pubis as much as 3-4 mm by 32 weeks AOGLordosis (forward curve of lumbar spine) may cause backache

  • Physiologic changes of PregnancyENDOCRINE 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 StatusPara - number of pregnancies that reached viability Gravida woman who is or has been pregnantPrimipara given birth to 1 child past the age of viabilityPrimigravida 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 upHistory:Personal/social/sexual historyMesntrual historyFamily historyPast medical historyGynecologic historyObstetric historyPhysical examinationInternal examinationDiagnostics examinations

  • Obstetric ScoringGravida Para GP TPAL TermPretermAbortionLivebirthexamples

  • DIAGNOSTICSURINALYSISCBCBLOODTYPINGHEPA B ANTIGENVDRL/RPRPAPSMEARULTRASOUND50 GRAMS ORAL GLUCOSE CHALLENGE TEST 24-28 weeks