LU 3 : Normal Pregnancy

What is pregnancy ?

• the period between conception and the complete birth of the product of conception

• pregnancy usually lasts about 40 weeks

• pregnancy is divided into three trimesters

What are the meaning of these terminology

• gestation

• early term

• full term

• late term

• post term

• gestation : singleton pregnancies last an average of 40 weeks from the first day of the last menstrual period to the estimated date of delivery

• early term : 37 0/7 - 38 6/7 weeks of gestation

• full term : 39 0/7 - 40 6/7 weeks of gestation

• late term : 41 0/7 - 41 6/7 weeks of gestation

• post term : 42 0/7 weeks of gestation and beyond

What are the meaning of these terminology ?

• gravidity

• gravida

• nulligravida

• primigravida

• multigravida

• gravidity : pregnancy

• gravida : number of pregnancies a woman has had

• nulligravida : never been pregnant

• primigravida : first time pregnant

• multigravida : pregnant more than once

What are the meaning of these terminology ?

• parity

• nulliparous

• primipara

• multi para

• grand multipara

• parity : number of births where the fetus has reached 24 weeks of gestation

• nulliparous : never born a child

• primipara : given birth for the first time

• multi para : given birth more than once

• grand multipara : given birth five or more times

What are the meaning of these terminology ?

• lie

• presentation

• lie : relationship of the long axis (spine) of the fetus to the long axis of the mother’s uterus

• presentation : part of the fetus in the lower pole of the uterus

What are the meaning of these terminology ?

• position

• crowned

• engaged

• denominator

• position : relationship of the denominator to the six areas of the mother’s pelvis

• crowned : When the Bi-parietals pass the ischial spines and head no longer recedes between contractions

• engaged : Bi-parietal diameters of the fetal head passes through pelvic brim

• denominator : part of fetus which determines the position

What are the duration of pregnancy in general and to each trimesters ?

• general : 40 weeks

• 1st trimesters : from conception to 12 weeks

• 2nd trimesters : 13 weeks to 28 weeks

• 3rd trimesters : 29 weeks to 40 weeks

What are the type of signs and symptoms of pregnancy ?

• Presumptive signs : suggest but not positively indicate pregnancy (describe by mother)

• Probable signs : strong indicators of pregnancy (observed by examiner)

• Positive signs : absolute confirmation of pregnancy

What are the examples of presumptive signs of pregnancy ?

• Amenorrhea (absence of menstruation)

• Quickening (fluttering sensation when fetus moves)

• Nausea & vomiting

• Breast changes such as enlargment

• Increase in micturition

What are the examples of probable signs of pregnancy ?

• Pigmentation changes (linear nigra)

• Chadwick’s sign (purplish color of cervix)

• Hegar’s sign (softening of lower uterus)

• Ballottement (detection of fetus floating in amniotic fluid)

• Goodell’s sign (softening of cervix)

What are the examples of positives signs of pregnancy ?

• ultrasound scanning of the fetus

• detection of fetal heart sounds

• palpation of fetal movement

• palpation of the entire fetus

The physiological changes of pregnancy are due to

• hormonal production

• circulation

• metabolism

What are the general changes to body for each trimester ?

• 1st trimester : baby begins to grow, increased urination, nausea

• 2nd trimester : baby’s weight increases, heartburn, leg cramps

• 3rd trimester : baby has more rapid growth and weight gain, backaches, breathlessness

What are the changes to reproductive system during pregnancy ?

• uterus enlarges by 20 times

• vagina become softer

• breasts increase in size and become full and tender

• cervix softens

What are the changes to musculoskeletal system during pregnancy ?

• relaxation of joints due to relaxin hormone

• posture and center of gravity shift

• increased back strain

• increased risk of carpal tunnel syndrome

What are the changes to respiratory system during pregnancy ?

• oxygen consumption increases by about 20%

• respiratory rate and depth increases

• nose bleed is common

• rib cage widens

What are the changes to cardiovascular system during pregnancy ?

• blood volume increases by 30-50%

• pulse rate increases by 10-15 beats per minute

• clotting factors increse

• 500-1000mls of blood to the uterus per minutes

What are the changes to gastrointestinal system during pregnancy ?

• gums appear red and swollen

• nausea and vomiting

• increased thirst and appetite

• decreased motility in large intestine causes constipation

What are the changes to urinary system during pregnancy ?

• kidneys increase in length and weight

• renal pelvis and ureter dilate and lengthen

• frequent urination

What are the changes to integumentary/skin system during pregnancy ?

• linea nigra (a black line in the midline of the abdmonen)

• striae gravidarum (stretch marks)

• chloasma (bronze type of facial pigmentation)

What are the changes to endocrine system during pregnancy ?

• pituitary gland enlarged

• heat intolerance

What are the gestational weight gain range for single pregnancy ?

What are the system to classify pregnancy status ?

• GPA system (Gravida/Para/Abortus)

• TPAL system or GTPAL system (Gravidity + term births, Premature births, abortions, living births)

A patient delivered twin pregnancy at term. How to note her in chart ?

• If the women has been pregnant once and delivered twins after 20 weeks, it should be Gravida 1 Para 1

• number of fetus delivered does not determine the Para/Parity

How to estimate gestational age ?

• LMP

• Add 7 days 9 months

• fundal height (cm = weeks POG)

How to estimate date of delivery ?

• using Naegele’s rule

• add 9 months and 7 days to the first day of the last menstrual period

How to estimate period of gestation ?