Download Feb.2017 Confirmation of pregnancy

Prepared by :
Ayda khader
Feb.2017
Confirmation of pregnancy:
Presumptive Indications of Pregnancy
1. Amenorrhea (cessation of menses)
 Pregnancy is suspected if more than 10 days elapsed since
the time of the expected onset.
2. Breast and Skin Changes
 Breast is enlarged and become tender
 Nipple become larger and more pigmented
 Secrete of colostrum in the 2nd half of pregnancy
 Darkening of areola
3. Nausea and Vomiting (morning sickness)
 Occur mainly in the morning
 Usually disappear near the end of the first trimester
4. Vaginal and Cervical Color Changes
 Chadwick’s signs = a bluish discoloration and congestion of
vaginal wall
5. Abdominal Striae (striae gravidarum )
 Appears in abdomen and sometimes in breast, and thigh because
of the stretch.
6. Fetal Movement (Quickening Sign)
 occurs between 16th and 20th week after the onset of last menses
7. Frequency of Urination
 Caused by pressure is exerted on the bladder by expanding
uterus
 Decrease when the uterus expands into the abdomen away from
the pelvis
 Reappear when the fetal head engages in the pelvis at the end of
pregnancy.
8. Fatigue
 Characteristic of early pregnancy that the direct cause unknown
but may be related to hormones changes
Probable Indications of Pregnancy
1. Abdominal Enlargement
Slow gradual increase of the abdomen size
2. Braxton Hicks Contraction
Irregular painless contractions of the uterus occurring
throughout pregnancy.
3. Ballottement
 Refers to sinking and rebounding of the fetus in its
surrounding amniotic fluid when taping the uterus suddenly
(occur at mid-pregnancy/ 16-28 weeks).
 It’s a strong indication of pregnancy
4. Change in the shape, size and consistency of
the uterus
 Uterus enlarges, elongates and decrease in thickness as
pregnancy progress
 Hegar’s sign: softening of the lower uterine segment at 6-8
weeks.
5. Changes in the cervix
 Goodell’s sign: softening of the cervix at 6-8 weeks
 The cervix remains firm during pregnancy in case of cervical
inflammation and carcinoma.
6. Pregnancy tests
 Human Chorionic Gonadotrophin (HCG) hormone appears in
the maternal serum and urine
. Positive Indications of Pregnancy
1. Auscultation of fetal heart sounds
 Fetal heart sounds can be heard with a fetoscope by 20to 24
weeks of gestation
 Electronic Doppler can detect heart motion at 10 weeks of
gestation.
2. Felt of fetal movement by the examiner
 Should be careful to be not deceived by similar peristaltic
movement of large intestine.
3. Visualization of the fetus
The fetus can be detected by transvaginal ultrasonography as early
as 4 weeks after the last menstrual period and by transabdominal
ultrasonography at 6 weeks.
. Maternal physiologic changes during pregnancy
The changes that occur in the body system of the
pregnant women caused by several factors:
1. Hormonal influences
2. Fetus growth inside the uterus
3. Maternal adaptation to physiological changes of
pregnancy
1. Reproductive System
A. Uterus
 The uterus develops to provide a nutritive and
protective environment in which the fetus will develop
and grow.
 Progesterone and estrogen produced by the corpus
lutium cause the decidua.
 Become thicker, more vascular at the fundus.
 The decidua provides a glycogen until to form placenta
 Increase in uterus weight and size.
 The uterus can be palpated supra publically by the end
of 3ed month that by 22 and 36 weeks of gestation the
fundus has reached the umbilicus and xiphoid
respectively.
 The uterus descends slightly into the pelvis during the
last 3 weeks
 Painless irregular contraction (Braxton Hick’s
Contraction) at the first two trimesters. During the
last trimester become more frequent and cause some
discomfort.
B. Cervix
 The cervical glands proliferate with increase mucus
production. The mucus form plug in the cervical canal
and block ascending of bacteria from the vagina into
the uterus.
 The obvious cervical changes occur in color and
consistency that the cervix becomes congested with
blood (Chadwick’s sign) due to estrogen stimulation
and soft (Goodell’s sign).
C. Vagina and Vulva
 Increase vascularity of the vagina cause vaginal wall to
appear bluish (Chadwick’s sign).
 Softening of vaginal tissue and loosens of connective
tissue cause distend of vaginal wall to prepare for
childbirth.
 The subsequent breakdown of glycogen into lactic acid
assists in producing a low vaginal pH which prevents
infection
D. Ovaries
 Ovulation ceases during
pregnancy because
circulating estrogen and progesterone are high that
inhibiting release of LH and FSH (these hormones are
necessary for ovulation).
 Progesterone produced in early pregnancy by special
glandular structure of the ovaries called corpus
luteum. Later the placenta produces it in increasing
quantities
2. Integumentary System
 Pigmentation changes occur ( increase of
melanin).
 Chloasma: patchy coloring on the face.
 Linea nigra: pigmented line running from the
pubis to the umbilicus.
 Striae gravidarum: thin and stretch marks appear
as red strips, its appers in the skin of the abdomen,
breast and thighs.
 Oily skin and acne may occur in pregnancy
3. Breast Changes
 Some women may experience tender and tingle in the
early weeks of pregnancy.
 The breast size increased by 2ed month
 Nipple becomes large, more deeply pigmented and
more erectile, Areola becomes broader and more
deeply pigmented.
 Colostrum may be experienced in some women by 2ed
trimester. It has protein and mineral but less sugar and
fat compared to mature milk.
4. Metabolic System
A. Weight Gain
 Women are encouraged to gain an adequate amount of
weight during pregnancy.
 Expected increase: total weight gains are 7-18 kg for
normal maternal pre-pregnancy weight, 12-18 kg for
underweight women, 7-11.5 kg for overweight and at
least 6-8 kg for obese women. Average weight gain for
twines pregnancies is 16-20.5 kg.
B. Water Metabolism
 Average women retains 6.5 liter of extra water during
pregnancy.
 Many pregnant women experience edema in the legs
and ankles.
 Carpal tunnel syndrome (pain, burning and numbness
of the hand and wrist) may be occurred in some
women results from compress of edema in the median
nerve.
C. Carbohydrate Metabolism
 Pregnancy is potentially diabetogenic.
D. Iron Metabolism
 Iron requirements increase that the needs for iron are
often exceed the available amounts.
 Supplementation of iron are necessary for several
weeks after pregnancy.
5. Cardiovascular System
A. Heart
 Diaphragm is progressively elevated during pregnancy and
displaced to the left and upward with moving the apex laterally.
 Heart murmur is common and usually disappears after delivery.
B. Circulation
 Heart beat usually increases from 10-20 beat/minute during
pregnancy.
 Cardiac volume increase by 10% and increase cardiac output
(reversed after childbirth).
C. Blood pressure
Blood pressure decreased slightly during first and second trimester
and by the end of third trimester blood pressure return to prepregnancy state.
D. Hematologic
 hemoglobin concentration at term averages 11g/dl.
 Leukocytes count is increased to 25.000 during labour with
unknown causes.
6. Respiratory System
 Maternal oxygen requirement increase by 15-20%
during pregnancy to meet fetal needs for oxygen
 Increase respiratory rate and reduce Pco2
 Diaphragm is elevated in the late of pregnancy due to
enlarged uterus.
7. Urinary System
 Glomerular filtration increases due to elevated level of human
placental lactogen (HPL) hormone during pregnancy
 Glycosuria and mild proteinuria may be evident during
pregnancy.
 Frequency of urination.
8. Gastrointestinal System
 Stomach and intestine are displaced upward and
laterally by enlarged uterus.
 Heart burn is common
 Hemorrhoid is common due to constipation resulted
from decreases of intestinal motility.
9. Musculoskeletal System
 Alteration in posture and walking due to increase in
the maternal weight which result in back pain.
 Increasing the mobility of pelvic joints and ligaments
in the second trimester resulting from increases the
relaxin and progesterone productions by the placenta.
 Calcium absorption and storage is increased starting
from the first trimester to meet fetal demands in the
late of pregnancy,