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• Average length of pregnancy is 40 weeks.
• pregnancy ranges from 38-42 weeks

Postpartum

• Lasts 6 weeks.
• Involution is the return of uterus to its pre-pregnant state.
• Subinvolution is the failure of the uterus to return to its pre-pregnant state.

Ovarian/Menstrual Cycle

• Average cycle lasts 28 days.
• Cycles range 23-35 days

Terms

• Menarche is the first menstruation, typically for women aged 9-16.
• Fertilization is also known as conception and impregnation.
• It involves the fusion of an egg and sperm.
• A zygote is the cell resulting from the union of an egg and sperm.
• Progesterone is a hormone of pregnancy
• Estrogen is a hormone of the menstrual cycle.
• During childhood, it is produced by the adrenal gland.
• Luteinizing hormone (LH) is a hormone of ovulation.
• Follicle-stimulating hormone (FSH) is a hormone for maturation and development of follicles.
• Ejaculation is 1ml in volume and contains 4-20 million sperm cells.

Childhood Estrogen

• During childhood, estrogen is low.
• Estrogen is produced by the adrenal gland during childhood.
• The amount is minimal due to hormonal balance and inactivity of the hypothalamus-pituitary-gonadal axis.

Menstrual Cycle - Part 1

• The start of the menstrual cycle is triggered by low estrogen during puberty.
• The hypothalamus releases Gonadotropin releasing hormone (GnRH).
• The APG secretes follicle-stimulation hormone (FSH) as a trigger.
• Activates one oocyte and its surrounding follicle-primordial (primary; young) follicle to grow and mature.
• Develops graafian follicles (GF), that contains follicular fluid high in estrogen but low in progesterone.
• The estrogenic/follicular/proliferative phase occurs.
• The endometrial cells that are attached to the uterus lining proliferate to prepare for possible implantation for pregnancy

Menstrual Cycle - Part 2

• APG detects high estrogen which releases luteinizing hormone (LH).
• GF ruptures and releases the egg during ovulation.
• Travels toward the fallopian tube (infundibulum) and waits for fertilization for 24-48 hours.
• If conception occurs corpus luteum remains throughout the majority of the pregnancy (16-20 weeks).
• If no conception, egg atrophies after 4-5 days.
• Corpus luteum remains for 8-10 days.
• Corpus luteum regresses and is replaced by fibrous tissue forming the corpus albicans.
• Progesterone and estrogen decrease
• Ischemic phase involves degeneration of the lining, mucus, blood, and egg for 1-3 days.
• Menses is the discharge of the lining, mucus, blood, and egg.
• During GF rupture the remaining cells of the follicles become acted on my LH.
• Lutein develops and fills the empty follicles creating a corpus luteum.
• Corpus luteum is high in progesterone (but low in estrogen) creating a luteal/secretory phase.
• Progesterone thickens the lining and mucus to prevent microorganisms from harming the pregnancy.
• It maintains pregnancy and prevents miscarriage and also relaxes the uterus to prevent contraction and labor.

Common Physiologic Changes During Pregnancy

• Subjective and lowest level of confirmatory.

Pain - Legs

• Normal cramps are due to low calcium and phosphorus
• Prevention includes calcium supplements (1g/day) and magnesium lactate/citrate BID (AM and PM).
• Avoid foot extension and tip toe
• Dorsiflex the foot with the knee extended for management.
• Abnormal clots are due to uterine pressure.
• Increased circulation, ambulation, leg elevation, and wearing elastic (anti-embolic) stockings for prevention.
  • Stockings should be worn before getting out of bed in the morning or after lying down for 30 minutes.
  • Length should be pantyhose and increased OFI

Back

• Normal lower back pain is due to progesterone and relaxin softening/relaxing pelvic joints.
• It is aggravated by lordosis.
• Prevention includes standing straight, supporting the pillow in the back, squatting, and wearing low-heeled shoes.
• Pelvic rocking can strengthen the lumbar spine and relaxation with hollowed stance.
• Hold for a minute.

Chest

• Normal heartburn/pyrosis is due to:
• Relaxed sphincter caused by P-R leading to decreased motility in GI resulting in constipation and flatulence and the stomach being pushed upward caused by enlarged uterus.
• Management includes small, more frequent feeding, slow chewing, waiting 2-3 hours after eating before lying down.
• Sleep leaning on the left and supported with 2 pillows
• Avoid Alka Seltzer, baking soda, tomato, and fatty food.

Head

• Normal new onset or new type headaches that should be mild and occasional.
• Manage with paracetamol
• Abnormal headaches that are severe, continuous, and unrelieved by paracetamol; visual changes need to be reported and may indicate hypertension(HTN).

Respiratory Changes

• Stuffy nose (nasal congestion) is caused by estrogen.
• Shortness of breath, especially on the 3rd trimester, is due to uterus enlargement.
• Baby engagement (descent) on the last 2 weeks of pregnancy will have a lightening effect on the mother.
• Enlarged uterus result sin speedy breaths (tachypnea).

Enlargement of Breasts

• Blue veins are caused by increased vascularity from estrogen.
• Hormones that ready the breasts for lactation are progesterone and human placental lactogen (HPL, human chorionic somatomammotropin).
• The areola darkens due to estrogen.
• Colostrum is secreted, high in IgA starting at 16 weeks of gestation.
• Colostrum lasts 2-3 days, then true milk appears and is produced by prolactin and ejected by oxytocin.
• Bilateral breast tenderness occurs due to milk filling or engorgement.
• Address the pain before continuing breastfeeding (BF) using cold compress for pain and warm compress for edema or swelling.
• Analgesic and continuation of BF is encouraged
• Dry and crack breast indicates mastitis that must be unilaterally treated with antibiotics, analgesics and continuation of BF stopping only with abscess.

Skin Changes

• Striae gravidarum- manage pruritus with cocoa butter lotion
• Kloasma/Chloasma/ Melasma is a mask of pregnancy appearing on cheeks and nose

Urinary frequency

• Increased bladder pressure occurs:
  • 1st trimester: Mild
  • 2nd trimester: Absent
  • 3rd trimester: Stronger (especially in the last 2 week)
• High hormones such as hCG stimulate urination with:
  • Increased first trimester caused by trophoblast cells
  • Decreased second trimester and retained water/sodium from aldosterone

Movement

• Quickening is first movement felt by the mother at the:
  • 20 weeks
  • 18-20 weeks in Primi
  • 16 weeks in Multi
  • Peak is 28 weeks until 38 weeks or engagement
• Kick count assesses fetal well-being
  • Frequency- once daily
  • Position- Left Recumbent
  • Time- after Meal for 1 hour
  • Rate- 10-12/hour
  • Actions:
    • Less than- ambulate
    • contraindication- snack/juice

Morning Sickness

• PHEG
  • Increased Progesterone
  • Increased hCG (1st trimester)
  • Increased Estrogen and decreased glucose
• SAD
  • Snack before meal
  • Small and frequent meals -Sourball, sips of carbonated drinks or sparkling water
• Avoid- Spicy, Seasoned, Sebo(fatty food), Sudden movement, Acupressure, Acupuncture

Tiredness

• 1st Tri - decreased 2/2 to glucose, increased metabolic demands, nausea
• 2nd Tri - Peak increased, plasma increases
• 3rd Tri- deprived sleep 2nd to uterus and fetal movement
• Relaxation- increase daily caloric intake - increase normal weight to 25-35bs

Supplemental/Medications

• Citrus food / cabbage (gas-forming food)
• Magnesium Hydroxide
• H2 Blockers
• Maalox
• Paracetamol
• Bedrest- check and report

Menses Cesson

• Due to high estrogen and feedback from FSH and LH
• High estrogen level Stop postpartum
• Return from menses

Lactational Amenorrhea Method(LAM)

1. Pure breastfeeding
2. Non mensural

palmar Eythema

due To:

• Calamine lotion
• Calamite lotion