PREGNANCY
PREPARED BY: BAI HAIRIA S. SOLAIMAN, RM, BSM
PREGNANCY
• It is the period from fertilization to birth.
• It starts when a male’s sperm fertilizes a female’s egg (ovum) in
the woman’s fallopian tube, making a (zygote) with 46
chromosomes.
• The zygote starts to divide, and after five to seven days of
dividing and growing, it attaches itself to the wall of the uterus.
The moment it is implanted in the wall of the uterus it becomes
an ( Embryo) and the placenta starts to develop.
• After 8 weeks, the developing embryo called (Fetus)
• The placenta give the embryo/fetus the oxygen and nutrition and
removes the waste through the umbilical cord.
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Pregnancy - How a Wonder is Born!
From PREGNACY to BIRTH
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ThomasSchwenke-knowledge
TIME FRAME: 19:35
THE NORMAL PREGNANCY LAST
ABOUT
280 DAYS
9 MONTHS
40 WEEKS
3 TRIMESTERS
Normal delivery could be from
38-42 weeks
Signs and Symptoms of
pregnancy
A. PRESUMPTIVE SIGNS:
(physiological changes noticed by the woman herself)
Symptoms:
1. Amenorrhea (absence of menstruation)
2. Breast changes- starting on the 4th week of pregnancy, breast
enlarge
3. Urinary frequency
4. Quickening- the 1st fetal movement felt by the mother
Cont.
A. PRESUMPTIVE SIGNS:
(physiological changes noticed by the woman herself)
5. Easy fatigability
6. Leukorrhea- Increase vaginal discharge
7. Nausea and vomiting (morning sickness)
8. Chadwick’s sign – discoloration of vulva
9. Skin changes:
> Striae gravidarum
> Linea nigra
> Chloasma
> Increase perspiration
> Hair grows rapidly
B. PROBABLE SIGNS:
(physiological and anatomical changes that can be
perceived by the health care provider)
1. Hegar’s sign – softening of the lower uterine segment which is felt
starting 6-8 weeks after LMP.
2. Uterine growth- The uterus doubles in size as early as 10 weeks and
pregnancy becomes obvious by 14 weeks.
3. Ballotement- refers to the rebound that occurs when the
examiner’s finger tap the floating fetus
4. Uterine souffle- A muffled swishing sound heard over the abdomen
in union with the mother’s heart beat.
5. Goodell’s sign- softening of the cervix
Cont.
B. PROBABLE SIGNS
6. Braxton-Hicks Contraction – They are painless palpable contractions
occurring at irregular interval and felt by the mother as sensation of tightness
over her abdomen.
7. Fetal outline – palpable at 24 weeks.
8. Positive pregnancy test results- detection of hCG in maternal urine or blood.
The tests are accurate but not 100%. hCG is present beginning 24-48 hours of
implantation. The earliest time that it can be detected in maternal serum is:
> 8 days after ovulation
> 23 days after LMP
> 5 days before the expected menstrual period
C. POSITIVE SIGNS:
(Objective signs of pregnancy noted by the
examiner by positive examination of the embryo)
1. FHT can be detected by Doppler at 12 weeks., by fethoscope at 16 weeks and by
stethoscope at 20 weeks.
2. Funic souffle – A swishing sound synchronous with fetal heart beat
3. Fetal movement- 20 weeks onward does examiner can felt
4. X-ray visualization of fetal skeleton as early as 14 weeks.
5. Utrasonograhic evidence of pregnancy:
> Abdominal pulse echo sonography can detect intrauterine pregnancy at 4-5
weeks
> small white gestational ring can be detected after 6 weeks.
> Fetal head and thorax can be identified by 14 weeks.
GROUP REPORTING:
Physiologic changes in pregnancy such as:
Reproductive System – BARA, DATUKUSIN, OMAR, PIKIT, WAHAB
Cardiovascular System – ALFONSO, DIKONG, MANGULAMAS, TORION,
PASANDALAN
Respiratory System- CAMID, DINDA, RICO, PAUNAT
Urinary System – SABPA, BLAH, BAJUNAID, EMAM
Gastrointestinal System- MAUYAG, MAGUID, HADJI MANAN, SALIK, LUMAWAN
Integumentary System- LACOTO, HAMALIAN, AMOS, SULA
Endocrine System- ABDULLAH, SUMALAY, IBRAHIM, KENIS
Skeletal System- FERY, ISMAEL, PANING, BICO
REFERENCES: MARIA LORETO EVANGELISTA SIA OUTLINE IN OBSTETRICS
PSYCHOLOGIC/EMOTIONAL
ADAPTATION OF PREGNANCY
• Acceptance of Pregnancy ( 1st trimester)
“I am pregnant” Acceptance of the reality of pregnancy.
• Acceptance of the fetus as a separate individual (2nd trimester)
“ I am going to have a baby” Quickening by 20 weeks gestation can be
very significant .
• Acceptance of Motherhood/ the Woman prepares for the Birth of
the baby and her role as a Mother ( 3rd trimester)
“ I am going to be a mother” begins to plan about the birth of the baby.
PRENATAL CARE
DEFINITION OF TERMS
• PRENATAL CARE – refers to the health care given to a woman and her
family during pregnancy.
• GRAVIDA – refers to a pregnant woman.
• NULLIGRAVIDA – a woman who has NEVER been pregnant.
• PRIMIGRAVIDA – a woman pregnant for the FIRST TIME.
• MULTIGRAVIDA – a woman who has had TWO or MORE pregnancies.
• PARA – the number of pregnancies that reached viability or the number
of pregnancies that reached 20 weeks or more, or # of fetus delivered
with weight of 500 grams or more.
PRENATAL CARE
• NULLIPARA – A woman who has never delivered a fetus that reached
the age of viability. Such woman may or may not have been pregnant
before.
• PRIMIPARA – A woman who has completed one pregnancy to
viability.
• MULTIPARA – A woman who has completed two or more pregnancies
to the age of viability.
• TERM INFANT – An infant born between 38-42 weeks gestation.
PRENATAL CARE
• POSTTERM INFANT – An infant born after 42 weeks gestation.
• PRETERM INFANT – An infant born before 38 weeks gestation.
• PARTURIENT- A woman in labor.
• PUERPERA – A woman who has just delivered (within 6 weeks after
delivery)
• LIVEBIRTH – A live birth is recorded when the infant born shows signs
of life namely: breathing, spontaneous movement of voluntary
muscles and heartbeat.
• STILLBIRTH – An infant born without signs of life.
PRENATAL CARE
• EARLY NEONATAL DEATH – Death of newborn within 7 weeks after
birth.
• LATE NEONATAL DEATH – An infant who died between 7-29 days after
birth.
• LOW BIRTH WEIGHT – An infant is considered LBW if the 1st newborn
weight taken is less than 2500 grams.
• LARGE FOR GESTATIONAL AGE- An infant with a birth weight of more
than 4000 grams.
Component of Prenatal Care (DOH)
• HISTORY TAKING
> Chief complaint
Personal Data
> Menstrual history
> Breast Health
> Contraceptive Use
> Medical History
Obstetric History
> History of past pregnancies
> History of present pregnancy
History of past pregnancies
• FPAL
F- No. of full term infants born after 37 weeks
P- No. of preterm infants born before 37 weeks
A- No. of spontaneous abortion
L- No. of living children
GP
G- No. of pregnancies irrespective of GA
P- No. of pregnancies that reached viability (20 weeks)
History of present pregnancy
• Inquired for last menstrual period (LMP) and compute for EXPECTED
DATE OF DELIVERY/CONFINEMENT (EDD/EDC)
To get EDD/EDC:
count back 3 months, add 7 days to the first day of LMP, and add 1 yr.
(Naegele’s Rule)
Formula: -3 + 7 + 1
Example:
• LMP: Month Day Year
MAY 20 2022
Solutions: -3 +7 +1
__________________________
EDD: February 27 2023
EXERCISES: ½ CROSSWISE
1. Patient Anne, a mother of three, visited the
clinic for her regularly scheduled check-up
(September 21, 2023). The midwife determines
that her last menstrual period occurred on May
20, 2023. Calculate Anne's EDC and AOG.
2. During her regularly scheduled check-up,
patient Joy visited the clinic (January 5, 2023).
She had her last menstrual period on August
15, 2022, according to the midwife. Calculate
Joy's EDC and AOG.
History of present pregnancy
• If the woman cannot remember her LMP, ask
her when she first felt the fetus move.
To get EDC for primigravida, add 22 weeks
to the date of quickening
To get EDC for multigravida, add 24 weeks
to the date of quickening.
PARAMETERS that can be used to
measure the duration of pregnancy
are the ff:
• LMP – This involves calculating the span of time from
the LMP to present
• BBT record or single coitus – Is an isolated coitus can
be dated or BBT record is available, the precise onset of
pregnancy can be dated.
• Quickening – Noted at 20 weeks in primis, 16 weeks in
multis
• Assessment of Fundic Height – measured to estimate
AOG, EDC and FETAL GROWTH RATE.
Following RULES:
• MC DONALD’S RULE - is used to calculate AOG
Formula:
Fundic height (cm) X 2/7 = AOG in lunar months
Fundic height (cm) X 8/7 = AOG in weeks
BARTOLOMEW’S RULE – is used to calculate AOG
Height of fundus is used to determine AOG, Fundic height is
determined by palpation and by relating to diffent landmarks in the
abdomen: umbilicus, symphisis pubis,xiphoid process.
JOHNSON’S RULE – is used to
calculate fetal wt. in grams.
• Formula:
Fundic height(cm) – N x K = fetal weight
K = 155 (constant)
N = 12 if engaged (do Leopold’s to find out)
N = 11 if not yet engaged
HAASE’S RULE – is used to
determine the length of fetus
HAASE’S RULE – is used to
determine the length of fetus
• Greater Fundic Height Indicates:
- multiple pregnancy
- miscalculated due date
- polyhydramnios
- hydatidiform mole
• Lesser Fundic Height Indicates:
- Fetal growth rate retardation
- Fetal death
- Error in estimating AOG
- Oligohydramnios
Component of Prenatal Care (DOH)
• PHYSICAL EXAMINATION
> weight, height, V/S, exams of conjunctiva & palms for pallor
> abdominal exam., (fundic height, fetal position, presentation
and FHT)
> examination: face, hands, lower extremities for EDEMA
> breast examination
> thyroid examination
LEOPOLD’S MANEUVER
Component of Prenatal Care (DOH)
• TREATMENT OF DISEASE
• TT IMMUNIZATION
TT1 ( anytime during pregnancy)
TT2 ( 1 month after TT1)
TT3 ( 6 months after TT2)
TT4 ( 1 year after TT3 or next pregnancy)
TT5 ( 1 year after TT4 or next pregnancy)
Component of Prenatal Care (DOH)
• IRON SUPPLEMENTATION
• HEALTH EDUCATION
• LABORATORY EXAMINATION
• ORAL DENTAL EXAMINATION
• REFERRAL WHEN NECESSARY
Laboratory tests
• Urine exam for albumin (URINALYSIS)
1. Collect urinary specimen by midstream or clean catch technique.
2. Benedict’s test to detect glycosuria.
3. Heat and acetic test to detect proteinuria.
4. Urinalysis in the 1st trimester is also performed to detect asymptomatic
bacteruria.
• Blood test
Hematocrit & haemoglobin at 28-32 weeks to detect anemia
> normal haemoglobin level bet. 12-16 mg/dl
> normal haematocrit count bet. 37-47 %
URINALYSIS MACHINE WITH
URINE DIPSTICK
RETURN DEMONSTRATION
•LEOPOLD’S MANEUVER
•PERINEAL FLUSHING
•PERINEAL SHAVING
