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PREGNANCY

By: shenellD

PregnancyPregnancyObjectives:• What happens

to an egg after fertiliZation?

• How does a baby develop in the uterus?

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Fertilization •The union of ovum and spermatozoa.• Fertilization occurs in the outer third of the fallopian tube – the ampullar portion.•other terms are conception, impregnation, or fecundation.•The critical time span during which fertilization may occur is about 72 hours.

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Steps in fertilizatio

n

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1.Following ovulation, as the ovum is extruded from the graafian follicle, it is surrounded by a ring of mucopolysaccharide fluid (zona pellucida) and a circle of cells (corona radiata). These structures increase the bulk of the ovum, facilitating it’s migration to the uterus. 

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2. The ovum and surroundings cells are propelled, into the fallopian tube by the fimbriae, the fine, hair-like structures that line the openings of the fallopian tubes.

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3. Only one ovum reaches maturity a month, a normal ejaculation of semen averages 2.5 ml of fluid containing 50 to 200 million spermatozoa per ml. or averages of 300-400 million per ejaculation. To promote the possibility of a sperm reaching the ovum, there is a reduction in the viscosity of cervical mucus at the time of ovulation.

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4. Spermatozoa deposited in the vagina reaches the cervix of uterus within 90 seconds after deposition ant the outer end of the fallopian tube in 5 minutes. The functional life of spermatozoa is 48 hours.

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5. Spermatozoa move by means of their flagella (tails) and uterine contraction through the cervix, the body of uterus toward the waiting ovum. All the spermatozoa that reaches the ovum cluster around the ovum’s protective layer of corona cells

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6. Hyaluronidase (a proteolytic enzyme) is released by the spermatozoa which acts to dissolve the layer of cells protecting the ovum.

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7. Only one spermatozoa is able to penetrate the cell membrane of the ovum. After it has done, cell membrane becomes impervious to other spermatozoa. 

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8. After penetration, the chromosomal material of the ovum and spermatozoa fuse and the structure is called zygote.

Sperm (23) + Egg (23) = Fertilized Cell (46)

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implantation

•occurs on the seventh day after fertilization•Is the contact between the growing structure and the uterine endometrium

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1. Once of fertilization is complete, the zygote migrate for 3 to 4 days to reach the body of uterus. This time mitotic cell division or cleavage begins. The first cleavage occurs at about 24 hours

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2. As the zygote reaches the uterus it consists of 16 to 50 cells. Its bumpy outward appearance is termed morula (from Latin word morus meaning “mulberry.”)

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3. The morula continues to multiply as it floats free in the uterine cavity for 3 or 4 more days. Large cells tend to mass at the periphery of the ball, leaving a fluid space surrounding an inner cell mass. The structure is now termed blastocyst. 

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4. The cells in the outer ring are known as trophoblast cells. They are the part of the structure that forms the placenta and membrane the inner cell called erythroblast cells is the portion that forms the embryo.

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5. After the 4th day of free floating, the residues of corona and zona pellucida are shed by growing structure. The blastocyst brushes against the rich uterine endometrium a process termed apposition. It attaches to the surface of the endometrium (termed adhesion) and settles down into soft folds (invasion)

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6. The blastocyst is able to invade the endometrium because as the trophoblast cells on the outside of blastocyst touch the endometrium, they produce proteolytic enzymes that dissolve the tissue they touch. This allows the structure to burrow into endometrium, receive some basic nourishment of glycogen and mucoprotein and establishes an effective communication network with the blood system of the endometrium.

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stages

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1 day post-ovulation1 Egg, 300 Million Sperm0.1 - 0.15 mmFertilization begins when a sperm penetrates an an egg and it ends with the creation of the zygote. Fertilization takes about 24 hours.

Stage 1: Fertilization

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Stage 2: Division

1.5 - 3 days post-ovulationFirst Cell DivisionWhen cell division produces sixteen cells, the zygote becomes mulberry shaped. It leaves the fallopian tube and three to four days after fertilization

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Stage 3: Implantation Begins

0.1 - 0.2 mm4 days post-ovulationAbout four days after fertilization, the egg enters the uterine cavity.Cell division continues, forming a cavity in the center of the egg. Cells flatten and compact on the inside of the cavity.The entire structure is now called a blastocyst.

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Stage 4: Implantation Begins

0.1 - 0.2 mm5 - 6 days post-ovulationThe blastocyst "hatches" around the sixth dayThe implantation site becomes swollen with new capillaries, and blood circulation begins

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Stage 5: Implantation Completed

0.1 - 0.2 mm7-12 days post-ovulationThe inner cell mass divides, rapidly forming a two-layered disc. The top layer of cells will become the embryo and amniotic cavity, while the lower cells become the yolk sac.Placenta begins forming

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Thank you!!!

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From…

Fertilization-The union of ovum and spermatozoa.zygote-chromosomal material of the ovum and spermatozoa fuse

Implantation-the contact from the growing structure to the

endometrium.

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blastocysts

• A blastocysts is a ball like structure composed of an inner cell mass, called embryonic disc or erythroblasts.

• The outer layer is the throphoblasts that gives rise to the placenta, fetal membranes, umbilical cord, and amniotic fluid.

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• the embryonic disc gives rise to the three primary layers which are:

Ectoderm- gives rise to the skin, hair, nails, sense organs, nervous system, mucous membrane of the mouth and anus.

Mesoderm- kidney musculoskeletal system, reproductive system and cardiovascular system

Entoderm- bladder,lining of the gastrointestinal tract, tonsils, thyroid gland, and respiratory system.

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trophoblasts• The important functions of

the trophoblasts is to absorb nutrients from the endometrium and secrete hormone HCG or human chorionic gonadotropin, necessary in prolonging the life of the corpus luteum

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Once implanted, the zygote is now

an embryo.

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Embryonic and fetal structures

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The decidua

• Decidua- latin word means “falling off”

• After implantation, the endometrium is referred to as decidua, the specialized endometrium of pregnancy. It is composed of 3 layers:

a) Decidua verab) Decidua basalisc) Dacidua capsularis

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• Decidua Basalis– part of the endometrium

lying directly under the embryo and where trophoblast cells are establishing communication with maternal blood vessels.

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• Decidua Capsularis–Stretches or encapsulates the surfaces of the trophoblast

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• Decidua Vera– the remaining portion of the

uterine lining– It fuses with decidua

capsularis when the gestational rings grows enough to occupy the entire uterine cavity.

– Like a blanket of the embryo– At birth the entire surface of

the uterus is stripped away, leaving the organ susceptible to hemorrhage and infection.

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the chorionic villi

• Chorionic villi- miniature villi, or probing “fingers” that reach out from the single layer of cells into the uterine endometrium.

• Two distinct layers:a) Syncytiotrophoblast or

syncytial layerb) Cytotrophoblast or

langhans’ layer

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• Syncytiotrophoblast or Syncytial Layer–outer layer responsible

in the production of HCG, Somatomammotropin (human placental lactogen), estrogen and progesterone.

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• Cytotrophoblast or Langhan’s Layer– Inner layer that protects

the growing embryo and fetus from infections organisms such as spirochete of syphilis.

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• The chorionic villi in contact with decidua basalis proliferate rapidly because they will receive rich blood supply from the uterus.

• Responsible for absorbing nutrients and oxygen from maternal blood stream and disposing fetal waste products including carbon dioxide.

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The placenta

• Placenta- latin for pancake, because of the appearance.

• It covers about half of the surface area of the internal uterus.

• It serves as the fetal lungs, kidneys, and gastrointestinal tract and a separate endocrine gland throughout the pregnancy.

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The placenta

• Arises out of trophoblast tissue. It contains 20 cotyledons and weighs 400-600 grams. The rate of uteroplacental blood flow in pregnancy increases about 50 ml/min at 10 weeks to 500 to 600 ml/min at term. It develops by the third month and formed by union of chorionic villi and deciduas basalis. 

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Placenta

Consists of an embryonic portion and a maternal portion

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placental Circulation

• oxygen and nutrients diffuse into the fetal blood from the maternal blood

• waste diffuses into the maternal blood from the fetal blood

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What is the function of yolk sac?

• Yolk sac appears to supply the nourishment only until implantation.

• After which, its main purpose is to provide a source of red blood cells until the embryo’s hematopoetic system is mature enough to perform this function.

• So, circulation starts as early as 16th day of life and heart beat as early as the 24th day.

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The umbilical cord

• Formed as chronic villi begins to function, initiating circulatory communication with the maternal blood pools joined together into larger veins and arteries; about 21 inches in length at term and 2cm in thickness

• Contains one vein and two arteries ( AVA)

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Functions• The bulk of the cord is a

gelatinous mucopolysaccharide called Wharton’s jelly which gives the cord body and protects therein and arteries from pressure 

• To transport oxygen and nutrients to the fetus from the placenta.

• Smooth muscle is abundant in the arteries of the cord and the construction of these muscles after birth contributes to homeostasis and helps prevent hemorrhage of the newborn.

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Fetal membranes

Fetal Membranes – membranes that surround the fetus and what give placenta the shiny appended

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Amniotic Fluid • Amniotic Fluid – forms

within the amniotic cavity and surrounds the embryo. Consist of 800 to 1200 ml of fluid at the end of pregnancy; contains fetal urine, lanugo from fetal skin, epithelial cells and subaqueous materials.–pH – 7.2; specific gravity

– 1.005 – 1.025

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Functions:• Provides a cushion against injury

• Protects the fetus from changes in temperature

• Protects the umbilical cord from pressure, protecting fetal oxygenation

• Aids muscular development

• Excretion collection system

• The fetus drinks the fluid

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Name Time Period

Ovum

Zygote

Embryo

FetusConceptus

From ovulation to fertilizationFrom fertilization to implantationFrom implantation to 5-8 weeksFrom 5-8 weeks until termDeveloping embryo or fetus and placental structure throughout pregnancy

TERMS TO DENOTE FETAL GROWTH

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Care of the pregnant woman

Physiologic change of pregnancy

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Local change

• Face – Chloasma – darkening patches of the face due to melanocyte stimulating hormone.

• “Mask of Pregnancy”

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• Breast – the areola darkens in color and diameter increase from 3.5 to 5 cm; formation of secondary areola.– blue veins become

prominent and the sebaceous glands of areola (Montgomery’s tubercles) enlarge and become protuberant

– by the 16 week- colostrums, a thin, watery, high protein fluid may be expelled from the nipples

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Abdomen– Diastasis; due to

overstretching of tissue to accommodate growing fetus and separation of rectus muscles. Bluish groove at the site of separation.

– Linea Nigra: a brown line running from the umbilicus to the symphysis pubis

– Striae Gravidarum: pink or reddish streaks on the sides of eh abdomen wall and on thigh due to rupture and atrophy of small segment of connective layer of the skin.

– Spider hemangiomas.

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• Vagina – Chadwick’s sign – purplish discoloration

• Leukorrhea – thick whitish vaginal discharge without signs of itching.

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• Cervix – Goodell’s sign – softening of the cervix

- formation of mucus plug (operculum) to seal out bacteria

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• Uterus - Hegar’s sign – softening of lower uterine segment – Braxton Hick’s Contractions:

occurs through out pregnancy

– Amenorrhea– Ballottement: during the 16th

to 20th week of pregnancy, a sudden push of the fetus

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Bi-manual pelvic exam to palpate uterus

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Signs and Symptoms of

Pregnancy 

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Presumptive Signs – largely subjective that are experienced by the woman but cannot be documented by the examiner least indicative of pregnancy

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A - amenorrhea B - breast changesC - color changes

S-striae gravidarum

M-melasma L-linea nigra

F- fatigue, nausea, vomiting

U- urinary frequency, uterine enlargement, leukorrhea

Q- quickening

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• Probable signs –(objective) Can be documented by the examiner but not considered positive diagnostic \findings.

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(+) positive pregnancy test

H - Hegar’s signC - Chadwick’s signG - Goodell’s signB - ballotementF - Fetal parts as felt

by the examiner

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Positive Signs – signs that confirm pregnancy• Fetal Heart sounds

(16th week)• Fetal Movements felt

by the examiner• Fetal Movement on

Sonogram• Fetal Outline (UTZ)

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Systemic Change during

pregnancy

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Cardiovascular System:• Heart rate increase 10-15

beats/ minute.• Blood pressure decrease

slightly in the second trimester due to lowered peripheral resistance to circulation but rises in the third trimester. 

• Cardiac output increase 20% -30% during first and second trimester to meet increase tissue demands

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• Supine hypotension Syndrome – the woman experience light-headedness, faintness and heart palpitation as the woman lies supine, the weight of uterus presses the vena cava, obstruction to the blood flow.

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• Pseudoanemia - as the plasma volume first increase, the concentration of hemoglobin and erythrocytes may decline – Increase in RBC creating Normal levels of RBC again (Inc. Iron Ferrous sulfate) S04.

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*Women need iron supplement

• 300-400 ml blood loss from normal delivery

• 800-1000 ml blood loss from cesarean delivery

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Respiratory System• Diaphragm rises as much

as 1inch; slight dyspnea may occur until lightening .

• Increased vital capacity, tidal volume, respiratory minute volume to supply maternal and fetal needs.

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Digestive System• Slowed gastrointestinal

motility and digestion.• Tooth loss due to

demineralization• Displacement of intestine

and compression of stomach.

• HYPERPTYALISM – increase salivation formation – increase level of estrogen.

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Common problems:1. Morning Sickness – nausea and

vomiting early in the morning. HCG and progesterone begin to rise. 

2. Heartburn - Pyrosis- reflux of stomach content into esophagus due to displacement of the stomach.

- decrease gastric motility; relieved by eating small meals frequently and not lying down immediately after eating, to help prevent reflux.

2. Pica - eating non-food substance.- abnormal craving for substance - The most common is craving for ice cube- Often accompanies iron deficiency anemia*Encourage to take iron supplements

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3. Constipation - because of reduced activity with GIT and pressure of growing fetus, andplacental hormone relaxing contribute to decreased gastric motility. 

4. Flatulence 5. Bleeding gums

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Urinary System • Increased urinary

frequency on the first and third trimester because of pressure on bladder

• Glomerular filtration rate increased 50%

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Glycosuria - because of increased excretion of sugar by lowered renal threshold.

- presence of sugar in the urine. 

Lower specific gravity – a result of increased urinary output

Polyuria – increase urine output

– additional sodium and therefore additional water.

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Endocrine System • Thyroid activity in

increased• HCG reaches a peak in the

third month• Secretions of oxytocin

which stimulates uterine contractions coupled with the drop in progesterone brings about labor

• Uterine contractions increase in frequency and intensity culminating in fetal expulsion

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Skeletal System • Gradual softening of pelvic ligaments and joints to facilitate passage of the body Lordosis (forward curvature of the lumber spinal standing with the shoulders back and abdomen forward in order to change center of gravity and make ambulation easier. “The Pride of Pregnancy”

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Discomforts of Pregnancy

and its Management

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Nausea and Vomiting• Eat five or six small,

frequent meals; in between meals, have crackers without fluid. Avoid foods high in carbohydrates, fried and greasy or strong odor.

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Fatigue•  Take frequent rest periods

during the day. A good resting position is a modified Sim’s position with top of the fetus on bed, not on the woman, and allows good circulation in the lower extremities

 

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Frequency of Urination• Kegel’s exercise

(alternately contracting and relaxing perineal muscles) helps to strength urinary control and decrease the possibility of stress incontinence and strength of perineal muscles for delivery

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Breast tenderness• Encourage to wear a

bra with a wide shoulder strap for support and to dress to avoid cold drafts.

 

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Flatulence•  Maintain daily bowel

movement; avoid gas-forming foods

Heartburn•  Avoid fatty, fried and

highly spiced foods; small frequent feedings;

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Constipation • Drink sufficient fluids; Eat

fruits and foods high in fiber and roughage; Exercise moderately; Avoid using mineral oil. (It interferes with the absorption of fat – soluble vitamins needed for good fetal growth and material health.

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Hemorrhoids • Apply ointments,

suppositories, warm compresses; Avoid constipation.

Insomnia• Prevent prolonged nap

time, offer milk, encourage warm bath.

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Backaches • Rest and improve

posture; use a firm mattres; Use a good abdominal support; wear comfortable shoes; Do exercises such as squatting, sitting, and pelvic rock.

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Varicosities, legs and vulva• Avoid long periods of

standing or sitting with legs crossed. Sit or lie with feet and hips elevated. Move about while standing to improve circulation; Wear support hose; avoid tight garters.

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Edema of legs and feet•  Elevate feet while

standing or lying down; Avoid standing or sitting in one position for long periods.

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Muscle cramps•  Extend cramped leg

and flex ankles, pushing foot upward with toes pointed toward knee; Increased calcium intake elevating the lower extremities frequently during the day.

 

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Dyspnea• Sit up. Lie on back

with arms extended above bed. Uses 2 or more pillows to sleep at night.

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Supine Hypotensive Syndrome

• Change position to left side to relieve pressure of uterus on interior vena cava.

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Leukorrhea (vaginal discharge)

• Practice proper cleansing an d hygiene; Avoid douche unless recommended by physician; A daily bath or shower to wash away secretions; Observe for signs of vaginal infection common in pregnancy.

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NEED A BREAK?

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Psychologic Changes of Pregnancy

Maternal Adaptations to

pregnancy  

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First Trimester: • Initial ambivalence about

pregnancy; pregnant woman places main focus upon self.

• Mother is self centered, baby is part of her.

• Grandparents are usually the first relatives to be told of pregnancy.

Accept the biological fact of pregnancy “I am pregnant”

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Second Trimester: • Acceptance of reality of

pregnancy; increased awareness and interesting fetus; introversion and feeling of well – being.

• Fantasizes about unborn child.

Accept the growing fetus as distinct from self and as a person to care of …..

“I am going to have a baby.”

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Third Trimester: • Anticipation of labor and

delivery and assuming mothering role, viewing infant as reality vs. fantasy; fears , fantasies and dreams about labor are common, “nesting” behaviors like preparing layette.

Prepare realistically for the birth and parenting of the child….. “I am going to be a mother.”

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Paternal Reactions to Pregnancy

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First Trimester: Ambivalence and anxiety about role change; concern or identification with wife’s discomfort (couvades)

 

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Second Trimester: Increased confidence and interest in mother care; difficulty relating to fetus; jealousy.

 

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Third TrimesterChanging self-concept; concern about body change; active involvement common fears about delivery, mutilation, or death of partner or fetus.

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Prenatal Period

 

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• Prenatal Visit• Schedule of Visit if no complications:

»Every 4 weeks, up to 32 weeks

»Every 2 weeks from 32-36 weeks (more frequently if problems exist.0

»Every week from 36-40 weeks

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History Taking Assessment of Risk Factors:Age: Under 16 or 35 (greater risk

over 40)– Pregnant adolescence have a

higher incidence of prematurity, pregnancy induced hypertension, cephalopelvic disproportion, poor nutrition and inadequate antepartal care.

– Women over 35 year old at risk for chromosomal disorder in infants, pregnancy – induced hypertension, and cesarean delivery; those over 35 years for first pregnancy may be at increased risk.

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Terminology• Gravidity

–#of current and completed pregnancies of any kind

• Parity–# of completed

pregnancies ≥ 20 weeks–not delivered infants

(e.g. twins)

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• Primigravida – a woman who is pregnant for the 1st child

• Primipara – a woman who had delivered, live born child; a woman who is pregnant for the first time.

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• Multigravida – a woman who has been pregnant previously.

• Multipara – a woman who has delivered 1 or more children previously

• Nulligravida – a woman who has never been pregnant.

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Parity (TPAL)T= Number of Term

BirthsP= Number of

Premature birthsA= Number of

AbortionsL= Number of living

children

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• G3/1-0-1-1:

Terminology

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• G3/1-0-1-1:–3rd Pregnancy

–1 Term delivery

–0 Preterm deliveries

–1 Abortion

–1 Living child

Terminology

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• G5/2-1-1-0:

Terminology

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• G5/2-1-1-0:–5th Pregnancy

–2 Term deliveries

–1 Preterm delivery

–1 Abortion

–0 Living children

Terminology

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• G2/0-2-0-3:

Terminology

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• G2/0-2-0-3:–2nd Pregnancy

–0 Term deliveries

–2 Preterm deliveries

–0 Abortions

–2 Living children

Terminology

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Physical AssessmentLEOPOLD’S MANUEVER

– a systematic method of observation and palpation to determine the presenting part, fetal position, presentation and engorgement. The woman should be in supine position with her knees flexed slightly.

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1st Maneuver• Palpate the superior

surface of the fundus• Facing the head part,

palpate for fetal part found in the fundus

 Leopold_first.flv

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2nd Maneuver • Palpate the sides of

uterus to determine where the fetal back is facing

• The left hand is left stationary on the left side of the uterus while the right hand palpates

• opposite side of the uterus from the top to bottom.

• Next, hold right hand stationary to immobilize the uterus, and palpate top to bottom on the left side

Leopold_second.flv

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3rd Maneuver• Palpate to discover what

is at the inlet of the pelvis.• Grasp the lower portion

of the abdomen just above the symphysis pubis between the thumb and index finger and try to press the thumb and finger together

• The presenting part is not engaged if the presenting part moves upward so an examiner’s hand can be pressed together.

Leopold_third.flv

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4th Maneuver• Palpate to determine the fetal

attitude• Place fingers on both sides of

the uterus 2 inches above inguinal ligaments. Press downward and inward

• The fingers of one hand will slide along the uterine contour and meet no obstruction; this is the fetal neck.

• The other hand will meet an obstruction and inch or so above the ligament, this is the fetal brow.

Leopold_final.flv

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Estimating Expected Date of Confinement

(EDC)

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Bartholomew’s Rule

• Estimate AOG:

3rd month(12 weeks)- fundus is slightly above symphisis pubis

5th month(20 weeks)- fundus ia at level of umbilicus

8th month(32 weeks)- below the xyphoid process

9th month(36 weeks)- same level

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Naegels’s RuleFormula:

3 months + 7 days + 1 year

Example Last Menstrual Period

April 20 1995

- 3 mos +7 days +1 year

January 27 1996 

EDC: January 27, 1996 

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• Example: solve the EDC

1.LMP September 15, 2009

2.LMP July 20, 20063.LMP August 5,

20004.LMP April 16, 20145.LMP January 01,

2009

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Mc Donald’s FormulaAge of Gestation

Formula:

Fundic height in cmx2/7 = AOG in months X 4 weeks = AOG in weeks

Example: Fundic heights is 21 cm

21 cm x 2 = 42 /7=6 months x 4 weeks = 24 weeks

fundal_height.flv

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• Example: solve for AOG

1. Fundic height is 18 cm

2. Fundic height is 24 cm

3. Fundic height is 32 cm

4. Fundic height is 16 cm

5. Fundic height is 20 cm

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Haase’s RuleFetal Length

• Formula:

1 to 5 months = months (squared)

6 to 10 months = months x 5

Examples5 months = 5 mos. = 25 cm length

8 months = 8 mos. x 5 = 40 cm length

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• Example: solve for fetal length

1. 6 mos. And 2 weeks

2. 4 months

3. 3 mos. And 3 weeks

4. 8 mos. And 1 week

5. 2 mos. And 2 weeks

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Johnson’s Rule (grams)

Fetal Weight

Formula: Fundic Height (cm) – n x k

N = 11 if part is not engaged

12 if part is engaged

K = 155 grams (standard value)

Example:

Fundic height = 21 cm not engaged

21 – 11 = 10 x 155 = 1, 550 grams

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• Example: solve for fetal weight

1. FH is 24 cm engaged

2. FH is 18 cm not engaged

3. FH is 20 cm engaged

4. FH is 16 cm not engaged

5. FH is 22 cm engaged

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NUTRITION DURING PREGNANCY

A. Weight gain- variable,but 25 lbs usually appropriate for average woman with single pregnancy.

• Recommended weight gain during pregnancy:

• 2-4 lbs in the first trimester

• 11-14 lbs in the second trimester

• 8-11 lbs in the third trimester (0.5 lb weekly)

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• Weight gain in pregnancy occurs from the both growth of fetus and accumulation of maternal stores:

• Breast 1.5 –3 lbs

• Fetus 7 lbs• Placenta 1.5 lbs• Uterus 2.5 lbs• Amniotic fluid 2 lbs• Blood volume 3.5

lbs

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NUTRITION DURING PREGNANCY

B. Specific nutrition needsCalories: +300 kcal/day. Never

< 1800 kcal/dayProtein: +30 g/day to ensure

intake of 74-76 g/dayIron: provide 100-200 mg/tab

dailyCalcium: 1200 mg/day

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Sexual activity during pregnancy

• Basically sex is permitted on 2nd trimester as long as your comfortable and you don’t have complications.

• Avoid breast massage since it may stimulate early uterine contractions.

• Side by side or woman on top position.

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Different Types of Exercise

TAILOR SITTING• It strengthens the thigh

and stretches perineal muscles. The woman should not put one ankle on top of the other but should place one leg in front of the other gently push on her knees (pushing them toward the floor until she feels her perineum “stretch”

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SQUATTING • Helps to stretch the

muscle of the pelvic floor. It should be done for 15 minutes day. The woman must keep her feet flat on the floor.

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PELVIC FLOOR CONTRACTIONS (KEGEL’S EXCERISE)

• Promotes perineal healing, increases sexual responsiveness and prevents stress, incontinence. While sitting at her desk or working around the house, the woman can tighten the muscles surrounding her vagina, relax tighten the muscles surrounding her rectum, relax, tighten her perineum, relax. It can be done 50-100 times daily

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ABDOMINAL MUSCLE CONTRACTIONS:

• Help strengthen abdominal muscles during pregnancy and prevents constipation in the postpartal period. It can be done in a standing or lying position. The woman tightens her abdominal muscles, then relaxes and she can repeat the exercise as often as she wishes.

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PELVIC ROCKING:• Helps relieve backache

during pregnancy. It can be done on hands and knees, lying down, sitting or standing. If the woman lies supine, she tightens her buttocks and flattens her lower back against the floor trying to lengthen her spine. She holds the position for 1 minute, then hollows her back or raises the lumbar spine of the floor.

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Questions??

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Pregnancy Song

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on the 1st month of pregnancy a“plus sign“ came to me…A missed pill brings a baby.

On the 2nd month of pregnancy my body said to me…two sore boobs!

On the 3rd month of pregnancy my husband said to me….3 months of no SEX!

On the 4th month of pregnancy my belly said to me…..4 bowls of ice cream

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On the 5th month of pregnancy my husband brought to me….

5 pickle pizzas!On the 6th month of pregnancy my

husband bought for me…

6 bars of chocolatesOn the 7th month of pregnancy my shower

brought to me…

7 identical strollersOn the 8th month of pregnancy my

husband said to me…

8th months of hormones!On the 9th month of pregnancy a bill was

sent to me…

9 thousand dollars!

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Thank you! Good luck on your prelim

exam