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 changes
Nausea
Vomiting
Frequent urination
Fatigue
Uterine enlargement
Quickening
Linea Nigra
Melasma
Striae 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
Chadwicks sign
Goodells sign
Hegars sign
UTS findings of gestational sac
Braxton Hicks contractions
Fetal outline felt by examiner

Positive Signs
Demonstration of fetal heart separate from the

mothers
Fetal movements felt by an examiner
Visualization of the fetus by ultrasound

Physiologic changes of Pregnancy

REPRODUCTIVE SYSTEM
Length increases from 6.5 to 32cm
Depth increases from 2.5 to 22 cm
Width expands from 4 to 24 cm
Weight increases from 50 to 1000 grams
Early 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 CHANGES
Breast size increases bec of hyperplasia of the mammary
alveoli and fat deposits
Areola darkens,diameter increases from 3.5 cm to 5 or
7.5 cm
Secondary areola forms additional darkening of the
skin surrounding the areola
By the 16th week, colostrum can be expelled from the
nipples

Physiologic changes of Pregnancy

INTEGUMENTARY CHANGES
gravidarum 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 muscle
Linea nigra/ melasma caused by inc in melanocyte
stimulating hormone
Vascular spiders or telangiectases and palmar erythema due
to increase estrogen

Physiologic changes of Pregnancy

RESPIRATORY CHANGES
Marked congestion or stufiness of the nasopharynx in
response to the inc estrogen levels
As 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 capacity
Residual 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 CHANGES
Cardiac output 25-50% increase
Blood 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 mg
Blood pressure decreases in the 2nd tri and increases
again in the 3rd tri

Physiologic changes of Pregnancy

GASTROINTESTINAL CHANGES
Increasing HCG and progesterone nausea and vomiting
but will subside after 3 months
Increase saliva formation because of estrogen
Acidity of the stomach decreases chronic gastric reflux
improved
Hyperthrophy 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 3050%)

Physiologic changes of Pregnancy

URINARY CHANGES
Increased levels of progesterone during pregnancy, the
ureters inc in diameter and bladder capacity increases to
about 1500 ml
Increase in frequency of urination
Uterus 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 CHANGES
Gradual 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 CHANGES
Thyroid gland slight enlargement; inc thyroid hormone
production
Parathyroid gland - slight enlargement; inc parathyroid
hormone production
Pancreas early: dec insulin production bec of heavy fetal
demand for glucose

after 1st tri: inc insulin production bec of antagonist properties of

estrogen, progesterone, HPL

Pituitary 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 pregnant
Primipara given birth to 1 child past the age of viability
Primigravida pregnant for the 1st time
Multipara has carried 2 or more pregnancies to viability
Multigravida- been pregnant previously
Nulligravida 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 examination
Internal examination
Diagnostics examinations

Obstetric Scoring
Gravida Para GP TPAL TermPretermAbortionLivebirth
examples

DIAGNOSTICS
URINALYSIS
CBC
BLOODTYPING
HEPA B ANTIGEN
VDRL/RPR
PAPSMEAR
ULTRASOUND
50 GRAMS ORAL GLUCOSE CHALLENGE TEST

24-28 weeks