Pregnancy

Maternal and Child Nursing NUR 362Lecture 3

The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):

Trimesters Weeks

First trimester (early pregnancy) 1-12

Second trimester (middle pregnancy) 13-28

Third trimester (late pregnancy) 29- 40

The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):

Regular visits during pregnancy

Prenatal visits

Q 4 weeks for 1st 28 weeks Q 2 weeks until 36 weeks, then

Q 1 week until childbirth

Important Estimates of Pregnancy

These are tools used in calculating the gestational age of the growing fetus and its Expected Date of Birth (EDB)

– Nagele’s Rule: Computation of expected date of birth. Formula: Last Menstrual Period in Day / Month / Year

(+7) (-3) (+1) = Expected Date of Birth

– Johnson’s Rule: estimates the weight of the fetus in grams.

The Diagnosis of the First Trimester

1. History and symptoms

A. Cessation of menstruation

This is the first frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.

1.The history and symptoms

B. Nausea and vomiting

Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).

1.The history and symptoms

C. Urinary symptoms

Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.

2. Signs

Breast changes

Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas may be noted.

Changes of the reproductive organs

Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested.

Cervix: Cyanosis and a gradual softening due to congestion.

Changes of the reproductive organs

Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12th week, the fundus of the uterus is usually palpable above the symphysis pubis.

C. Supplementary examination

Pregnancy test

The laboratory test for pregnancy are based on the identification of human chorionic gonadotrophin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.

Basal body temperature (BBT)

A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

Ultrasonography

There are trans-vaginal and abdominal Ultrasonagraphys.

A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period.

Ultrasonography

Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week.

Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

The diagnosis of the second and the third trimester pregnancy

Symptoms Abdominal enlargement and

fetal movement generally occurs after the 18th to 20th week of gestation.

Signs

The uterus continues to enlarge

Fetal movement (quickening) can usually be seen or heard after 18th week of gestation

Height of the uterine top

xiphoid

Signs

Fetal heart sound can be heard at rate varies from 120 to 140 beats per minute.

The fetal body can usually be palpated by the 18th to 20th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

Fetal heart

Other Examinations

X-ray. It is rarely used recently because the harmfulness to the fetus.

Fetal electrocardiogram. A fetal electrocardiogram can first be recorded at about the 12th week of pregnancy.

Different methods of pregnancy diagnosis

Fetal lie & fetal Presentation

Fetal lie: the relationship between the long axis of the mother and the long axis of the fetus. (longitudinal lie and transverse lie)

Fetal presentation: the portion of the fetus that descends into pelvis first.