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Pregnancy new ppt

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This is for level 2 of FCC, CN. NCM 201 topic pregnancy. you can download and convert the files for your references.. thanks. gudluck<<33

This is for level 2 of FCC, CN. NCM 201 topic pregnancy. you can download and convert the files for your references.. thanks. gudluck<<33

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  • This is a great Power Point. Could I please have a copy of this. You did an awesome job. Everything is in this PPt that is needed to study.
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    Pregnancy new ppt Pregnancy new ppt Presentation Transcript

    • PREGNANCY
      By: shenellD
      7/4/2010
      shenellD
    • Pregnancy
      Objectives:
      What happens to an egg after fertiliZation?
      How does a baby develop in the uterus?
      7/4/2010
      shenellD
    • Fertilization
      • The union of ovum and spermatozoa.
      • Fertilization occurs in the outer third of the fallopian tube – the ampullar portion.
      • other terms are conception, impregnation, or fecundation.
      • The critical time span during which fertilization may occur is about 72 hours.
      7/4/2010
      shenellD
    • Steps in fertilization
      7/4/2010
      shenellD
    • 1.Following ovulation, as the ovum is extruded from the graafian follicle, it is surrounded by a ring of mucopolysaccharide fluid (zonapellucida) and a circle of cells (corona radiata). These structures increase the bulk of the ovum, facilitating it’s migration to the uterus. 
      7/4/2010
      shenellD
    • 2. The ovum and surroundings cells are propelled, into the fallopian tube by the fimbriae, the fine, hair-like structures that line the openings of the fallopian tubes.
      7/4/2010
      shenellD
    • 3. Only one ovum reaches maturity a month, a normal ejaculation of semen averages 2.5 ml of fluid containing 50 to 200 million spermatozoa per ml. or averages of 300-400 million per ejaculation. To promote the possibility of a sperm reaching the ovum, there is a reduction in the viscosity of cervical mucus at the time of ovulation.
      7/4/2010
      shenellD
    • 4. Spermatozoa deposited in the vagina reaches the cervix of uterus within 90 seconds after deposition ant the outer end of the fallopian tube in 5 minutes. The functional life of spermatozoa is 48 hours.
      7/4/2010
      shenellD
    • 5. Spermatozoa move by means of their flagella (tails) and uterine contraction through the cervix, the body of uterus toward the waiting ovum. All the spermatozoa that reaches the ovum cluster around the ovum’s protective layer of corona cells
      7/4/2010
      shenellD
    • 6. Hyaluronidase(a proteolytic enzyme) is released by the spermatozoa which acts to dissolve the layer of cells protecting the ovum.
      7/4/2010
      shenellD
    • 7. Only one spermatozoa is able to penetrate the cell membrane of the ovum. After it has done, cell membrane becomes impervious to other spermatozoa. 
      7/4/2010
      shenellD
    • 8. After penetration, the chromosomal material of the ovum and spermatozoa fuse and the structure is called zygote.
      Sperm (23) + Egg (23) = Fertilized Cell (46)
      7/4/2010
      shenellD
    • implantation
      • occurs on the seventh day after fertilization
      • Is the contact between the growing structure and the uterine endometrium
      7/4/2010
      shenellD
    • 1. Once of fertilization is complete, the zygote migrate for 3 to 4 days to reach the body of uterus. This time mitotic cell division or cleavage begins. The first cleavage occurs at about 24 hours
      7/4/2010
      shenellD
    • 2. As the zygote reaches the uterus it consists of 16 to 50 cells. Its bumpy outward appearance is termed morula (from Latin word morus meaning “mulberry.”)
      7/4/2010
      shenellD
    • 3. The morula continues to multiply as it floats free in the uterine cavity for 3 or 4 more days. Large cells tend to mass at the periphery of the ball, leaving a fluid space surrounding an inner cell mass. The structure is now termed blastocyst. 
      7/4/2010
      shenellD
    • 4. The cells in the outer ring are known as trophoblast cells. They are the part of the structure that forms the placenta and membrane the inner cell called erythroblast cells is the portion that forms the embryo.
      7/4/2010
      shenellD
    • 5. After the 4th day of free floating, the residues of corona and zonapellucida are shed by growing structure. The blastocyst brushes against the rich uterine endometrium a process termed apposition. It attaches to the surface of the endometrium (termed adhesion) and settles down into soft folds (invasion)
      7/4/2010
      shenellD
    • 6. The blastocyst is able to invade the endometrium because as the trophoblast cells on the outside of blastocyst touch the endometrium, they produce proteolytic enzymes that dissolve the tissue they touch. This allows the structure to burrow into endometrium, receive some basic nourishment of glycogen and mucoprotein and establishes an effective communication network with the blood system of the endometrium.
      7/4/2010
      shenellD
    • stages
      7/4/2010
      shenellD
    • Stage 1: Fertilization
      1 day post-ovulation
      1 Egg, 300 Million Sperm
      0.1 - 0.15 mm
      Fertilization begins when a sperm penetrates an an egg and it ends with the creation of the zygote. Fertilization takes about 24 hours.
      7/4/2010
      shenellD
    • Stage 2: Division
      1.5 - 3 days post-ovulation
      First Cell Division
      When cell division produces sixteen cells, the zygote becomes mulberry shaped. It leaves the fallopian tube and three to four days after fertilization
      7/4/2010
      shenellD
    • Stage 3: Implantation Begins
      0.1 - 0.2 mm
      4 days post-ovulation
      About four days after fertilization, the egg enters the uterine cavity.
      Cell division continues, forming a cavity in the center of the egg. Cells flatten and compact on the inside of the cavity.
      The entire structure is now called a blastocyst.
      7/4/2010
      shenellD
    • Stage 4: Implantation Begins
      0.1 - 0.2 mm
      5 - 6 days post-ovulation
      The blastocyst "hatches" around the sixth day
      The implantation site becomes swollen with new capillaries, and blood circulation begins
      7/4/2010
      shenellD
    • Stage 5: Implantation Completed
      0.1 - 0.2 mm
      7-12 days post-ovulation
      The inner cell mass divides, rapidly forming a two-layered disc. The top layer of cells will become the embryo and amniotic cavity, while the lower cells become the yolk sac.
      Placenta begins forming
      7/4/2010
      shenellD
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    • 7/4/2010
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    • 7/4/2010
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    • Thank you!!!
      7/4/2010
      shenellD
    • From…
      Fertilization-The union of ovum and spermatozoa.
      zygote-chromosomal material of the ovum and spermatozoa fuse
      Implantation-the contact from the growing structure to the endometrium.
      7/4/2010
      shenellD
    • blastocysts
      A blastocysts is a ball like structure composed of an inner cell mass, called embryonic disc or erythroblasts.
      The outer layer is the throphoblasts that gives rise to the placenta, fetal membranes, umbilical cord, and amniotic fluid.
      7/4/2010
      shenellD
    • the embryonic disc gives rise to the three primary layers which are:
      Ectoderm- gives rise to the skin, hair, nails, sense organs, nervous system, mucous membrane of the mouth and anus.
      Mesoderm- kidney musculoskeletal system, reproductive system and cardiovascular system
      Entoderm-bladder,lining of the gastrointestinal tract, tonsils, thyroid gland, and respiratory system.
      7/4/2010
      shenellD
    • 7/4/2010
      shenellD
    • trophoblasts
      The important functions of the trophoblasts is to absorb nutrients from the endometrium and secrete hormone HCG or human chorionic gonadotropin, necessary in prolonging the life of the corpus luteum
      7/4/2010
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    • 7/4/2010
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    • Once implanted, the zygote is now an embryo.
      7/4/2010
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    • Embryonic and fetal structures
      7/4/2010
      shenellD
    • The decidua
      Decidua- latin word means “falling off”
      After implantation, the endometrium is referred to as decidua, the specialized endometrium of pregnancy. It is composed of 3 layers:
      Deciduavera
      Deciduabasalis
      Daciduacapsularis
      7/4/2010
      shenellD
    • DeciduaBasalis
      part of the endometrium lying directly under the embryo and where trophoblast cells are establishing communication with maternal blood vessels.
      7/4/2010
      shenellD
    • DeciduaCapsularis
      Stretches or encapsulates the surfaces of the trophoblast
      7/4/2010
      shenellD
    • Decidua Vera
      the remaining portion of the uterine lining
      It fuses with deciduacapsularis when the gestational rings grows enough to occupy the entire uterine cavity.
      Like a blanket of the embryo
      At birth the entire surface of the uterus is stripped away, leaving the organ susceptible to hemorrhage and infection.
      7/4/2010
      shenellD
    • 7/4/2010
      shenellD
    • the chorionic villi
      Chorionic villi- miniature villi, or probing “fingers” that reach out from the single layer of cells into the uterine endometrium.
      Two distinct layers:
      Syncytiotrophoblast or syncytial layer
      Cytotrophoblast or langhans’ layer
      7/4/2010
      shenellD
    • Syncytiotrophoblast or Syncytial Layer
      outer layer responsible in the production of HCG, Somatomammotropin (human placental lactogen), estrogen and progesterone.
      7/4/2010
      shenellD
    • Cytotrophoblastor Langhan’s Layer
      Inner layer that protects the growing embryo and fetus from infections organisms such as spirochete of syphilis.
      7/4/2010
      shenellD
    • The chorionic villi in contact with deciduabasalis proliferate rapidly because they will receive rich blood supply from the uterus.
      Responsible for absorbing nutrients and oxygen from maternal blood stream and disposing fetal waste products including carbon dioxide.
      7/4/2010
      shenellD
    • 7/4/2010
      shenellD
    • The placenta
      Placenta- latin for pancake, because of the appearance.
      It covers about half of the surface area of the internal uterus.
      It serves as the fetal lungs, kidneys, and gastrointestinal tract and a separate endocrine gland throughout the pregnancy.
      7/4/2010
      shenellD
    • The placenta
      Arises out of trophoblast tissue. It contains 20 cotyledons and weighs 400-600 grams. The rate of uteroplacental blood flow in pregnancy increases about 50 ml/min at 10 weeks to 500 to 600 ml/min at term. It develops by the third month and formed by union of chorionic villi and deciduas basalis. 
      7/4/2010
      shenellD
    • Placenta
      Consists of an embryonic portion and a maternal portion
      7/4/2010
      shenellD
    • placental Circulation
      • oxygen and nutrients diffuse into the fetal blood from the maternal blood
      • waste diffuses into the maternal blood from the fetal blood
      7/4/2010
      shenellD
    • What is the function of yolk sac?
      Yolk sac appears to supply the nourishment only until implantation.
      After which, its main purpose is to provide a source of red blood cells until the embryo’s hematopoetic system is mature enough to perform this function.
      So, circulation starts as early as 16th day of life and heart beat as early as the 24th day.
      7/4/2010
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    • 7/4/2010
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    • 7/4/2010
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    • 7/4/2010
      shenellD
    • The umbilical cord
      Formed as chronic villi begins to function, initiating circulatory communication with the maternal blood pools joined together into larger veins and arteries; about 21 inches in length at term and 2cm in thickness
      Contains one vein and two arteries ( AVA)
      7/4/2010
      shenellD
    • Functions
      The bulk of the cord is a gelatinous mucopolysaccharide called Wharton’s jelly which gives the cord body and protects therein and arteries from pressure 
      To transport oxygen and nutrients to the fetus from the placenta.
      Smooth muscle is abundant in the arteries of the cord and the construction of these muscles after birth contributes to homeostasis and helps prevent hemorrhage of the newborn.
      7/4/2010
      shenellD
    • Fetal membranes
      • Fetal Membranes – membranes that surround the fetus and what give placenta the shiny appended
      7/4/2010
      shenellD
    • Amniotic Fluid
      Amniotic Fluid – forms within the amniotic cavity and surrounds the embryo. Consist of 800 to 1200 ml of fluid at the end of pregnancy; contains fetal urine, lanugo from fetal skin, epithelial cells and subaqueous materials.
      pH – 7.2; specific gravity – 1.005 – 1.025
      7/4/2010
      shenellD
    • Functions:
      Provides a cushion against injury
      Protects the fetus from changes in temperature
      Protects the umbilical cord from pressure, protecting fetal oxygenation
      Aids muscular development
      Excretion collection system
      The fetus drinks the fluid
      7/4/2010
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    • 7/4/2010
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    • TERMS TO DENOTE FETAL GROWTH
      7/4/2010
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    • Care of the pregnant woman
      Physiologic change of pregnancy
      7/4/2010
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    • Local change
      Face – Chloasma – darkening patches of the face due to melanocyte stimulating hormone.
      “Mask of Pregnancy”
      7/4/2010
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    • 7/4/2010
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    • Breast – the areola darkens in color and diameter increase from 3.5 to 5 cm; formation of secondary areola.
      blue veins become prominent and the sebaceous glands of areola (Montgomery’s tubercles) enlarge and become protuberant
      by the 16 week- colostrums, a thin, watery, high protein fluid may be expelled from the nipples
      7/4/2010
      shenellD
    • Abdomen
      Diastasis; due to overstretching of tissue to accommodate growing fetus and separation of rectus muscles. Bluish groove at the site of separation.
      Linea Nigra: a brown line running from the umbilicus to the symphysis pubis
      StriaeGravidarum: pink or reddish streaks on the sides of eh abdomen wall and on thigh due to rupture and atrophy of small segment of connective layer of the skin.
      Spider hemangiomas.
      7/4/2010
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    • 7/4/2010
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    • Vagina – Chadwick’s sign – purplish discoloration
      Leukorrhea– thick whitish vaginal discharge without signs of itching.
      7/4/2010
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    • Cervix –Goodell’s sign – softening of the cervix
      - formation of mucus plug (operculum) to seal out bacteria
      7/4/2010
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    • 7/4/2010
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    • Uterus -Hegar’s sign – softening of lower uterine segment
      Braxton Hick’s Contractions: occurs through out pregnancy
      Amenorrhea
      Ballottement: during the 16th to 20th week of pregnancy, a sudden push of the fetus
      7/4/2010
      shenellD
    • Bi-manual pelvic exam to palpate uterus
      7/4/2010
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    • 7/4/2010
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    • Signs and Symptoms of Pregnancy 
      7/4/2010
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    • Presumptive Signs – largely subjective that are experienced by the woman but cannot be documented by the examiner least indicative of pregnancy
      7/4/2010
      shenellD
    • A - amenorrhea
      B - breast changes
      C - color changes
      S-striaegravidarum
      M-melasma
      L-lineanigra
      F- fatigue, nausea, vomiting
      U- urinary frequency, uterine enlargement, leukorrhea
      Q- quickening
      7/4/2010
      shenellD
    • Probable signs –(objective) Can be documented by the examiner but not considered positive diagnostic findings.
      7/4/2010
      shenellD
    • (+) positive pregnancy test
      H - Hegar’s sign
      C - Chadwick’s sign
      G - Goodell’s sign
      B - ballotement
      F - Fetal parts as felt by the examiner
      7/4/2010
      shenellD
    • Positive Signs – signs that confirm pregnancy
      Fetal Heart sounds (16th week)
      Fetal Movements felt by the examiner
      Fetal Movement on Sonogram
      Fetal Outline (UTZ)
      7/4/2010
      shenellD
    • Systemic Change during pregnancy
      7/4/2010
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    • Cardiovascular System:
      Heart rate increase 10-15 beats/ minute.
      Blood pressure decrease slightly in the second trimester due to lowered peripheral resistance to circulation but rises in the third trimester. 
      Cardiac output increase 20% -30% during first and second trimester to meet increase tissue demands
      7/4/2010
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    • Supine hypotension Syndrome – the woman experience light-headedness, faintness and heart palpitation as the woman lies supine, the weight of uterus presses the vena cava, obstruction to the blood flow.
      7/4/2010
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    • Pseudoanemia - as the plasma volume first increase, the concentration of hemoglobin and erythrocytes may decline – Increase in RBC creating Normal levels of RBC again (Inc. Iron Ferrous sulfate) S04.
      7/4/2010
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    • *Women need iron supplement
      300-400 ml blood loss from normal delivery
      800-1000 ml blood loss from cesarean delivery
      7/4/2010
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    • Respiratory System
      Diaphragm rises as much as 1inch; slight dyspnea may occur until lightening .
      Increased vital capacity, tidal volume, respiratory minute volume to supply maternal and fetal needs.
      7/4/2010
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    • Digestive System
      Slowed gastrointestinal motility and digestion.
      Tooth loss due to demineralization
      Displacement of intestine and compression of stomach.
      HYPERPTYALISM – increase salivation formation – increase level of estrogen.
      7/4/2010
      shenellD
    • Common problems:
      1. Morning Sickness – nausea and vomiting early in the morning. HCG and progesterone begin to rise. 
      2. Heartburn - Pyrosis- reflux of stomach content into esophagus due to displacement of the stomach.
      - decrease gastric motility; relieved by eating small meals frequently and not lying down immediately after eating, to help prevent reflux.
      2. Pica - eating non-food substance.
      - abnormal craving for substance
      - The most common is craving for ice cube
      - Often accompanies iron deficiency anemia
      *Encourage to take iron supplements
      7/4/2010
      shenellD
    • 3. Constipation - because of reduced activity with GIT and pressure of growing fetus, and
      placental hormone relaxing contribute to decreased gastric motility. 
      4. Flatulence 
      5. Bleeding gums
      7/4/2010
      shenellD
    • Urinary System 
      Increased urinary frequency on the first and third trimester because of pressure on bladder
      Glomerular filtration rate increased 50%
      7/4/2010
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    • Glycosuria - because of increased excretion of sugar by lowered renal threshold.
      - presence of sugar in the urine. 
      Lower specific gravity – a result of increased urinary output
      Polyuria –increase urine output
      – additional sodium and therefore additional water.
      7/4/2010
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    • Endocrine System 
      Thyroid activity in increased
      HCG reaches a peak in the third month
      Secretions of oxytocin which stimulates uterine contractions coupled with the drop in progesterone brings about labor
      Uterine contractions increase in frequency and intensity culminating in fetal expulsion
      7/4/2010
      shenellD
    • Skeletal System 
      Gradual softening of pelvic ligaments and joints to facilitate passage of the body Lordosis(forward curvature of the lumber spinal standing with the shoulders back and abdomen forward in order to change center of gravity and make ambulation easier. “The Pride of Pregnancy”
      7/4/2010
      shenellD
    • Discomforts of Pregnancy and its Management
      7/4/2010
      shenellD
    • Nausea and Vomiting
      Eat five or six small, frequent meals; in between meals, have crackers without fluid. Avoid foods high in carbohydrates, fried and greasy or strong odor.
      7/4/2010
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    • Fatigue
       Take frequent rest periods during the day. A good resting position is a modified Sim’s position with top of the fetus on bed, not on the woman, and allows good circulation in the lower extremities
       
      7/4/2010
      shenellD
    • Frequency of Urination
      Kegel’s exercise (alternately contracting and relaxing perineal muscles) helps to strength urinary control and decrease the possibility of stress incontinence and strength of perineal muscles for delivery
      7/4/2010
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    • Breast tenderness
      Encourage to wear a bra with a wide shoulder strap for support and to dress to avoid cold drafts.
       
      7/4/2010
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    • Flatulence
       Maintain daily bowel movement; avoid gas-forming foods
      Heartburn
       Avoid fatty, fried and highly spiced foods; small frequent feedings;
      7/4/2010
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    • Constipation
      Drink sufficient fluids; Eat fruits and foods high in fiber and roughage; Exercise moderately; Avoid using mineral oil. (It interferes with the absorption of fat – soluble vitamins needed for good fetal growth and material health.
      7/4/2010
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    • Hemorrhoids
      Apply ointments, suppositories, warm compresses; Avoid constipation.
      Insomnia
      Prevent prolonged nap time, offer milk, encourage warm bath.
      7/4/2010
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    • Backaches
      Rest and improve posture; use a firm mattres; Use a good abdominal support; wear comfortable shoes; Do exercises such as squatting, sitting, and pelvic rock.
      7/4/2010
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    • Varicosities, legs and vulva
      Avoid long periods of standing or sitting with legs crossed. Sit or lie with feet and hips elevated. Move about while standing to improve circulation; Wear support hose; avoid tight garters.
      7/4/2010
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    • Edema of legs and feet
       Elevate feet while standing or lying down; Avoid standing or sitting in one position for long periods.
      7/4/2010
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    • Muscle cramps
       Extend cramped leg and flex ankles, pushing foot upward with toes pointed toward knee; Increased calcium intake elevating the lower extremities frequently during the day.
       
      7/4/2010
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    • Dyspnea
      Sit up. Lie on back with arms extended above bed. Uses 2 or more pillows to sleep at night.
      7/4/2010
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    • Supine Hypotensive Syndrome
      Change position to left side to relieve pressure of uterus on interior vena cava.
      7/4/2010
      shenellD
    • Leukorrhea (vaginal discharge)
      Practice proper cleansing an d hygiene; Avoid douche unless recommended by physician; A daily bath or shower to wash away secretions; Observe for signs of vaginal infection common in pregnancy.
      7/4/2010
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    • NEED A BREAK?
      7/4/2010
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    • PsychologicChanges of Pregnancy
      Maternal Adaptations to pregnancy
       
      7/4/2010
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    • First Trimester:
      Initial ambivalence about pregnancy; pregnant woman places main focus upon self.
      Mother is self centered, baby is part of her.
      Grandparents are usually the first relatives to be told of pregnancy.
      • Accept the biological fact of pregnancy “I am pregnant”
      7/4/2010
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    • Second Trimester:
      Acceptance of reality of pregnancy; increased awareness and interesting fetus; introversion and feeling of well – being.
      Fantasizes about unborn child.
      • Accept the growing fetus as distinct from self and as a person to care of …..
      “I am going to have a baby.”
      7/4/2010
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    • Third Trimester:
      Anticipation of labor and delivery and assuming mothering role, viewing infant as reality vs. fantasy; fears , fantasies and dreams about labor are common, “nesting” behaviors like preparing layette.
      • Prepare realistically for the birth and parenting of the child….. “I am going to be a mother.”
      7/4/2010
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    • Paternal Reactions to Pregnancy
      7/4/2010
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    • First Trimester: Ambivalence and anxiety about role change; concern or identification with wife’s discomfort (couvades)
       
      7/4/2010
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    • Second Trimester: Increased confidence and interest in mother care; difficulty relating to fetus; jealousy.
       
      7/4/2010
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    • Third Trimester
      Changing self-concept; concern about body change; active involvement common fears about delivery, mutilation, or death of partner or fetus.
      7/4/2010
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    • Prenatal Period 
      7/4/2010
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    • Prenatal Visit
      Schedule of Visit if no complications:
      Every 4 weeks, up to 32 weeks
      Every 2 weeks from 32-36 weeks (more frequently if problems exist.0
      Every week from 36-40 weeks
      7/4/2010
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    • History Taking
      Assessment of Risk Factors:
      Age: Under 16 or 35 (greater risk over 40)
      Pregnant adolescence have a higher incidence of prematurity, pregnancy induced hypertension, cephalopelvic disproportion, poor nutrition and inadequate antepartal care.
      Women over 35 year old at risk for chromosomal disorder in infants, pregnancy – induced hypertension, and cesarean delivery; those over 35 years for first pregnancy may be at increased risk.
      7/4/2010
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    • Terminology
      Gravidity
      #of current and completed pregnancies of any kind
      Parity
      # of completed pregnancies ≥ 20 weeks
      not delivered infants (e.g. twins)
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    • Primigravida – a woman who is pregnant for the 1st child
      Primipara – a woman who had delivered, live born child; a woman who is pregnant for the first time.
      7/4/2010
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    • Multigravida– a woman who has been pregnant previously.
      Multipara – a woman who has delivered 1 or more children previously
      Nulligravida– a woman who has never been pregnant.
      7/4/2010
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    • Parity (TPAL)
      T= Number of Term Births
      P= Number of Premature births
      A= Number of Abortions
      L= Number of living children
      7/4/2010
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    • G3/1-0-1-1:
      Terminology
      7/4/2010
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    • G3/1-0-1-1:
      3rd Pregnancy
      1 Term delivery
      0 Preterm deliveries
      1 Abortion
      1 Living child
      Terminology
      7/4/2010
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    • G5/2-1-1-0:
      Terminology
      7/4/2010
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    • G5/2-1-1-0:
      5th Pregnancy
      2 Term deliveries
      1 Preterm delivery
      1 Abortion
      0 Living children
      Terminology
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    • G2/0-2-0-3:
      Terminology
      7/4/2010
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    • G2/0-2-0-3:
      2nd Pregnancy
      0 Term deliveries
      2 Preterm deliveries
      0 Abortions
      2 Living children
      Terminology
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    • Physical Assessment
      LEOPOLD’S MANUEVER
      a systematic method of observation and palpation to determine the presenting part, fetal position, presentation and engorgement. The woman should be in supine position with her knees flexed slightly.
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    • 1st Maneuver
      Palpate the superior surface of the fundus
      Facing the head part, palpate for fetal part found in the fundus
       Leopold_first.flv
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    • 2nd Maneuver
      Palpate the sides of uterus to determine where the fetal back is facing
      The left hand is left stationary on the left side of the uterus while the right hand palpates
      opposite side of the uterus from the top to bottom.
      Next, hold right hand stationary to immobilize the uterus, and palpate top to bottom on the left side
      Leopold_second.flv
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    • 3rd Maneuver
      Palpate to discover what is at the inlet of the pelvis.
      Grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and index finger and try to press the thumb and finger together
      The presenting part is not engaged if the presenting part moves upward so an examiner’s hand can be pressed together.
      Leopold_third.flv
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    • 4th Maneuver
      Palpate to determine the fetal attitude
      Place fingers on both sides of the uterus 2 inches above inguinal ligaments. Press downward and inward
      The fingers of one hand will slide along the uterine contour and meet no obstruction; this is the fetal neck.
      The other hand will meet an obstruction and inch or so above the ligament, this is the fetal brow.
      Leopold_final.flv
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    • 7/4/2010
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    • Estimating Expected Date of Confinement (EDC)
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    • Bartholomew’s Rule
      Estimate AOG:
      3rd month(12 weeks)- fundus is slightly above symphisis pubis
      5th month(20 weeks)- fundusia at level of umbilicus
      8th month(32 weeks)- below the xyphoid process
      9th month(36 weeks)- same level
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    • Naegels’sRule
      Formula:
      3 months + 7 days + 1 year
      Example Last Menstrual Period
      April 20 1995
      - 3 mos+7 days+1 year
      January 271996 
      EDC: January 27, 1996 
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    • Example: solve the EDC
      LMP September 15, 2009
      LMP July 20, 2006
      LMP August 5, 2000
      LMP April 16, 2014
      LMP January 01, 2009
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    • Mc Donald’s Formula
      Age of Gestation
      Formula:
      Fundicheight in cmx2/7 = AOG in months X 4 weeks = AOG in weeks
      Example: Fundic heights is 21 cm
      21 cm x 2 = 42 /7=6 months x 4 weeks = 24 weeks
      fundal_height.flv
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    • Example: solve for AOG
      Fundic height is 18 cm
      Fundic height is 24 cm
      Fundic height is 32 cm
      Fundic height is 16 cm
      Fundic height is 20 cm
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    • Haase’sRuleFetal Length
      Formula:
      1 to 5 months = months (squared)
      6 to 10 months = months x 5
      Examples
      5 months = 5 mos. = 25 cm length
      8 months = 8 mos. x 5 = 40 cm length
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    • Example: solve for fetal length
      6 mos. And 2 weeks
      4 months
      3 mos. And 3 weeks
      8 mos. And 1 week
      2 mos. And 2 weeks
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    • Johnson’s Rule (grams)
      Fetal Weight
      Formula:Fundic Height (cm) – n x k
      N = 11 if part is not engaged
      12 if part is engaged
      K = 155 grams (standard value)
      Example:
      Fundicheight = 21 cm not engaged
      21 – 11 = 10 x 155 = 1, 550 grams
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    • Example: solve for fetal weight
      FH is 24 cm engaged
      FH is 18 cm not engaged
      FH is 20 cm engaged
      FH is 16 cm not engaged
      FH is 22 cm engaged
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    • NUTRITION DURING PREGNANCY
      Weight gain- variable,but 25 lbs usually appropriate for average woman with single pregnancy.
      Recommended weight gain during pregnancy:
      2-4 lbs in the first trimester
      11-14 lbs in the second trimester
      8-11 lbs in the third trimester (0.5 lb weekly)
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    • Weight gain in pregnancy occurs from the both growth of fetus and accumulation of maternal stores:
      Breast 1.5 –3 lbs
      Fetus 7 lbs
      Placenta 1.5 lbs
      Uterus 2.5 lbs
      Amniotic fluid 2 lbs
      Blood volume 3.5 lbs
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    • NUTRITION DURING PREGNANCY
      B. Specific nutrition needs
      • Calories: +300 kcal/day. Never < 1800 kcal/day
      • Protein: +30 g/day to ensure intake of 74-76 g/day
      • Iron: provide 100-200 mg/tab daily
      • Calcium: 1200 mg/day
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    • Sexual activity during pregnancy
      Basically sex is permitted on 2nd trimester as long as your comfortable and you don’t have complications.
      Avoid breast massage since it may stimulate early uterine contractions.
      Side by side or woman on top position.
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    • Different Types of Exercise
      TAILOR SITTING
      It strengthens the thigh and stretches perineal muscles. The woman should not put one ankle on top of the other but should place one leg in front of the other gently push on her knees (pushing them toward the floor until she feels her perineum “stretch”
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    • SQUATTING 
      Helps to stretch the muscle of the pelvic floor. It should be done for 15 minutes day. The woman must keep her feet flat on the floor.
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    • PELVIC FLOOR CONTRACTIONS (KEGEL’S EXCERISE)
      Promotes perineal healing, increases sexual responsiveness and prevents stress, incontinence. While sitting at her desk or working around the house, the woman can tighten the muscles surrounding her vagina, relax tighten the muscles surrounding her rectum, relax, tighten her perineum, relax. It can be done 50-100 times daily
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    • ABDOMINAL MUSCLE CONTRACTIONS:
      Help strengthen abdominal muscles during pregnancy and prevents constipation in the postpartal period. It can be done in a standing or lying position. The woman tightens her abdominal muscles, then relaxes and she can repeat the exercise as often as she wishes.
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    • PELVIC ROCKING:
      Helps relieve backache during pregnancy. It can be done on hands and knees, lying down, sitting or standing. If the woman lies supine, she tightens her buttocks and flattens her lower back against the floor trying to lengthen her spine. She holds the position for 1 minute, then hollows her back or raises the lumbar spine of the floor.
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    • Questions??
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    • Pregnancy Song
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    • on the 1st month of pregnancy a“plus sign“ came to me…
      A missed pill brings a baby.
      On the 2nd month of pregnancy my body said to me…
      two sore boobs!
      On the 3rd month of pregnancy my husband said to me….
      3 months of no SEX!
      On the 4th month of pregnancy my belly said to me…..
      4 bowls of ice cream
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    • On the 5th month of pregnancy my husband brought to me….
      5 pickle pizzas!
      On the 6th month of pregnancy my husband bought for me…
      6 bars of chocolates
      On the 7th month of pregnancy my shower brought to me…
      7 identical strollers
      On the 8th month of pregnancy my husband said to me…
      8th months of hormones!
      On the 9th month of pregnancy a bill was sent to me…
      9 thousand dollars!
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    • Thank you! Good luck on your prelim exam
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