Post on 24-Dec-2015
description
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