Normal Pregnancy PDF

NORMAL PREGNANCY Under supervision Dr : hoda albendary  Group of the presentation: Group A Group B 1. Nada El-Saeed AbdelMurdi 2. salsabel Mohamed Mariam Mohamed Aamer 3. Souad Reda Fouad Mariam...

NORMAL PREGNANCY Under supervision Dr : hoda albendary  Group of the presentation: Group A Group B 1. Nada El-Saeed AbdelMurdi 2. salsabel Mohamed Mariam Mohamed Aamer 3. Souad Reda Fouad Mariam Abozaid 4. Salma Essam Maisa Tharwat 5. Amera Fahem Rahma Khaled 6. Sara Gharbia Hager Radwan 7. Dina Nofal Yomna Naeem 8. Rawda Mahmoud 9. Sanaa Elsabhy 10.Hager Mohamed 11.Shireen Mohamed 12.Soaad Zahra 13.Rufaida Hani  Conception and Fetal Development Fertilization: It is union of the sperm with ovum in the fallopian tube The sex of the infant is determined at Fertilization Implantation: Implantation is the process by which the blastocyst penetrates the superficial layer of the endometrium Time of implantation: Implantation begins about the 6th or 7th day & is complete about the 11th day after fertilization Once the implantation has taken place, the endometrium is called the The placenta is completely formed and functioning from 10-12 weeks after fertilization  Functions of the Mature Placenta  The placenta is completely formed & functioning from 10-12 weeks after fertilization.  1-Respiration:  - The fetus obtains oxygen and excretes carbon dioxide through the placenta.  2-Nutrition:  - Food for the fetus comes from the mother's diet which has been broken down into simpler forms.  3-Storage:  - The placenta metabolizes glucose that is stored in the form of glycogen and reconverted to glucose as required.  - It also stores iron and fat and soluble vitamins.  4-Excretion:  - Carbon dioxide is the main substance excreted from the fetus.  - Bilirubin and very small amounts of urea and uric acid are also excreted 5-Protection: - The placenta provides a limited barrier to infection.. - Rubella virus and some drugs can also cross to the fetus. - Antibodies are transferred to the fetus from the mother and give immunity to the infant for the first 3 months after birth 6-Endocrine: - Human chorionic gonadotrophin (HCG) forms the basis of pregnancy tests as it is excreted in the mother's urine. - Its function is to stimulate the growth and activity of the corpus luteum  The Placenta at Term - THE PLACENTA IS A ROUND FLAT MASS, ABOUT 20CM IN DIAMETER AND 2.5CM THICK AT ITS CENTRE. - IT WEIGHS ONE-SIXTH OF THE INFANT'S WEIGHT AT TERM. 1-THE MATERNAL SURFACE - THIS SURFACE IS DARK RED IN COLOUR. 2-THE FETAL SURFACE THE AMNION COVERING THE FETAL SURFACE GIVES IT A WHITE, SHINY APPEARANCE. Origin Fetal:  Amniotic fluid is secreted by the amnion that covers the placenta and umbilical cord, and fluid exuded from feta vessels in the placenta. Fetal urine also contributes  to the volume from the 10th week of pregnancy.  Maternal: - Fluid exudate from maternal vessels in thedecidua. Volume - Throughout pregnancy, the amniotic fluid increases and the normal volume is 500-1500 ml. Polyhydrammos: amniotic fluid more than 150OmI Oligohydramnios: amniotic fluid less than 50OmI Pregnancy : - It is a period between conception and delivery of the products of conception , the usual duration in the human is 280 days (40±2 ) weeks. Physiological changes during pregnancy Related definitions: Ante: means before. Natal: means delivery. Antenatal: means before delivery. Antenatal care: comprehensive health supervision of a pregnant woman before delivery. Prenatal : time before delivery. Gravida : any pregnancy, regardless of duration. It includes the present pregnancy. Para : number of births after 20 weeks' gestation regardless of whether the infants were born alive or dead. Fetal Circulation Primigravida : a woman pregnant for the first time. Multigravida: a woman who is in her second or a subsequent pregnancy. Nuligravida : a woman who has not given birth at more than 20 weeks' gestation. Primipara : a woman who has given birth to a fetus ( dead or alive ) that has reached 20 weeks' gestation  Multipara : a woman who has given birth two or more times at more than 20 weeks' gestation. Stillbirth : A fetus born dead after 20 weeks' gestation. LMP: Last menstrual period. Pregnancies are dated from the first day of the LMP EDC: Estimated date of confinement (EDD: estimated date of delivery) For a rough estimate: Add 7 days to 1st day of LMP, then add 9 months. (Nagele rule) Linea Nigra: This is a dark line that runs from the umbilicus to the symphysis pubis and may extend as high as the sternum. It is a hormone- induced pigmentation. Noted in some women during the later months of pregnancy (after 20 weeks).  Striae Gravidarum (Stretch Marks). Fine pinkish white or gray lines resulting from streching of skin during pregnancy. They generally appear on the woma's abdomen,breats ,thighs and buttocks. Usually appears in the second half of pregnancy ( between 6 to 12 wks) Cholosma --- brownish pigmentation of the face during pregnancy; also called ―mask of pregnancy‖Or it is a butterfly pigmentation may appear on cheeks and nose,it disappear after delivery Braxton Hicks contraction:- Irregular, mild ,painless uterine contractions that occur throughout pregnancy; they become stronger in the last trimester  Hegar‘s sign -- A softening of the lower segment of the uterus found upon palpation in the second or third month of pregnancy suggesting pregnancy. It occurs between 6 to 12 wks (bimanual examination) Goodell‘s sign --- softening of the cervix, uterus and vagina during pregnancy. Chadwick‘s sign-- bluish discoloration of the cervix, vagina, and labia during pregnancy as a result of vascular congestion Palmer sign:Intermittent uterine contraction early in pregnancy detected by bimanual examination.  Leucorrhea: it is colorless, non effective normal vaginal discharge due to hormonal changes occur during pregnancy Amenorrhea: Absence of menstruation Quickening: It‘s the first time at which the mother feels fetal movements. o PG: usually occurs between the 18th and 20th week o MG: usually occurs between the 16th and 18th week. Ptyalism: increase of saliva. Ballottement: It refers to the fetal movement in the amniotic fluid  Definition of antenatal Care: It refers to the care that given to an expected mother from time of conception is confirmed until the begging of labor.  Significance of prenatal care: To reduce maternal and prenatal mortality and morbidity rates. To improve the physical and mental health of women and children. To prepare the woman for labor, lactation and care of her infant. To detect early and treat properly complicated conditions that could endanger the life or impair the health of the mother or the fetus.  Elements of antenatal care: 1. Complete history taking(personal history, menstrual history, family history, past history of previous pregnancy, obstetric history, present complain 2. Physical examination (general and local) 3. Laboratory investigation 4. Health education 5. General examination Schedule of Antenatal Care Visits: Regular antenatal care can detect anemia, hypertensive disease, infections and other existing conditions and diseases that lead to high-risk pregnancy. Antenatal visits should take place: Before 28th weeks gestation (every 4 weeks) From 28th-36th weeks (every 2 weeks) Thereafter (every week) In a normal pregnancy, with no complications, a minimum of three antenatal visits is acceptable in the first 20 weeks  Weight gain: *During the 1st trimester, the pregnant woman gains about 1-2 kg. * During the 2 A trimester, the pregnant woman gains about 6-7 kg. * During the3 rd trimester, the pregnant woman gains about 3-4 kg. Immunization * All pregnant women should be fully immunized with tetanus toxoid vaccine in order to prevent neonatal tetanus. * If TT vaccine is not given before, it should be given during pregnancy in the form of 2 doses, 4 weeks apart starting from the third month. *Remaining TT doses should be completed lateraccording to the approved schedule Danger signs during pregnancy: Pregnant women should be encouraged to report and seek advice as soon as any of  the following occurs: Persistent vomiting. Severe persistent abdominal pain. Vaginal bleeding. Severe headache. Sudden swelling of face, fingers and feet. Blurring of vision. Sudden escape of fluid from the vagina. Dysuria, oliguria or anuria Diagnosis of Pregnancy based on many factors. Pregnancy signs & symptoms Probable evidence Hagar's sign. Gödel's signs. Positive pregnancy test. Presumptive signs: 1. Amenorrhea. 2. Nausea& vomiting. 3. Fatigue 4. Urinary frequency. 5. Breast& skin changes. 6. Quickenin Positive signs of pregnancy: 1. Visualization of fetal sac by ultrasound 2. Hearing FHS by Doppler or stethoscope 3. Felt fetal movement 4. Palpate fetal parts Positive evidences or Sure sings of pregnancy Hearing of fetal heart rate: usually heard between 16th and 20th week of gestation with a fetoscope and the 10th and 12th week of gestation with a Doppler stethoscope. Feeling of fetal movement by the examiner (after about 20 weeks' gestation). Ultrasonography: to confirm fetal outline ; shows the gestational sac as early as fifth week.