In this assessment and management describe about the reproductive health ,disorder of reproductive health and about pre conception ,genetic counseling and the physiological changes in the reproductive system of pregnant women .briefly knowledge about hematological changes and also the changes of cardiovascular system during pregnancy . the important role of endocrine gland during pregnancy .thyroid and the important role of a hormones and their maintenance .and their minor ailments in pregnancy or discomforts of pregnancy .sign and symptoms of pregnancy

1. ASSESSMENT AND
MANAGEMENT OF
PREGNANCY
(ANTENATAL)
BY MEENAKSHI

2. NORMAL PREGNANCY
• It is measured in weeks, from the first day of the woman's last menstrual cycle to
the current date. A normal pregnancy can range from 38 to 42 weeks. Infants
born before 37 weeks are considered premature. Infants born after 42 weeks are
considered postmature

3. DEFINITION : HEALTH
• According to WHO Health is defined as a state of complete physical , mental and
social well being not merely absence of disease or infirmity.
• Definition : Reproductive health
• Reproductive health or sexual health or hygiene addresses the reproductive
processes , functions and system at all stages of life.

4. DISORDER OF REPRODUCTION
• Reproductive disorder are : disease involving the reproductive tract infection
congenital abnormalities cancer of reproductive system and sexual dysfunction
eg: birth defect : congenital heart disease, down syndrome, cleft lip and cleft
palate.
Developmental Disorder or developmental disability who has mental or physical
impairment.
• Reduced fertility : due to exposure to lead , exposure to chemicals that may
disrupt hormonal activity.

5. DISORDER OF REPRODUCTION
• Menstrual disorder: Dysmenorrhea ( painful cramps)Menorrhagia(heavy bleeding)
Amenorrhea(absence of menstruation)Endocrine problem may too lead to
problem with fertility the endocrine system made up of all the body different
hormones regulate all biological process in the body from conception through
adulthood and into old age including the development of brain and nervous
system the growth and function of the reproductive system as well as metabolism
and blood sugar levels.

6. PRE CONCEPTIONAL CARE
DEFINITION
• Pre Conceptional care is define as the necessary care a women receive before
getting pregnant it includes identification of the problems and risk factors that
may affect the health of the mother and the baby and also involved steps that can
be taken to reduce these risk factors (birth defects).

7. COMMUNICATION SKILLS
• Communication skills : To ask question about sensitive subject , social support ,
substance abuse , domestic violence , sexual abuse .
• Maternal age : when a baby is born to a women between the ages of 20 to 34 .
Teenage mothers have increased chance of premature delivery and IUGR babies.
35 or older delivery may have chromosomal abnormalities , obstetrical
emergency like premature separation of placenta , abortion ,pre eclampsia , and
still birth .

8. MENSTRUAL HISTORY : NORMALLY MENSTRUATION OCCUR AT 28 DAYS
INTERVALS PLUS OR MINUS 3 DAYS .
• Personal medical history : seizure disorder , DM, HTN,TB,TSH.
• Obstetric history : date of delivery term or preterm , abortion , ectopic pregnancy
. (Types of delivery Lscs , spontaneous , forcep , vacuum ).
• Family history : any birth defect or disorder may appear in later in life .

9. GENETIC COUNSELING
• Genetic counseling : is the process of evaluating family history and medical
record , ordering genetic test , evaluating the results of this investigation helping
parents understand and reach decisions about what to do next.

10. PHYSIOLOGICAL CHANGES
DURING PREGNANCY
• Physiological changes during pregnancy :
• pregnancy is associated with normal physiological changes that
assist fetal survival as well as prepare the mother for labour .
• Causes of physiological changes in pregnancy .
• Metabolic demands brought on by the fetus , placenta and uterus.
due to increase levels of pregnancy hormones i.e. progesterone
and estrogen . Mechanical pressure from the expanding uterus
during mid pregnancy .

11. PHYSIOLOGICAL CHANGES IN THE REPRODUCTIVE
SYSTEM OF PREGNANT WOMEN .
• Vulva : it becomes vascular, hypertrophied , pigmented , and in some
women varicose veins appear.
• Vagina : it becomes vascular , edematous .looks bluish( jacquemiers
sign) soft when feel vaginal secretions are acidic , there is increased
amounts of vaginal mucus and leucorrhea due to secretions of
estrogen.

12. UTERUS
• During pregnancy there is an increase in weight at term weight 900
- 1000gm and measures 35 cm in length
• Volume of uterine cavity :
• In non pregnant state the volume of uterine cavity is 10 ml and
increase to 5 liter during pregnancy.

13. MUSCLES
• Outer - longitudinal layer
• middle - vascular layer
• inner - circular layer
• uterine muscle fibres undergo hyperplasia and hypertrophy upto 12
weeks.
• contractile protein (Actinomycin)increase muscles contract and
relax.
• uterine vessels increase in size and number.

14. ISTHMUS
• at term it measure 7.5cm-10cm in length . the circularly arranged muscle fibers
function as a sphincter in early pregnancy and help the fetus to stay in uterus so
incompetent sphincter leads to abortion.
• cervix :
• during pregnancy , cervix become vascular , edematous and soft (Goodell sign).
• its length doubles and volume increases.
• mucus production increases to plug the canal (helps to prevent ascending
infection from contaminating the fetus).

15. CERVIX
• near the beginning of labour cervix shortens ,effaces and begins to open ,dilates.
• show appears , it is the first indication that effective labour has begun.
• Fallopian tubes :
• Fallopian tubes hypertrophied , become vascular with patchy decidua.
• Ovary :
• Ovaries hypertrophy and become vascular.
• ovulation ceases (stops) throughout pregnancy.

16. OVARY
• corpus luteum of menses persists and enlarges to 2.5 cm till 8th week on HCG
effect of trophoblast.
• progesterone of corpus luteum supports decidua upto 7 weeks of pregnancy.
• Breast :
• Changes in breast : the vascularity and size of breast increases.
• Total weight become 0.4kg and volume 1 and half times more.

17. BREAST
• Enlarged breast from 16 week , secretes a clear sticky yellowish fluid called
colostrum .areola becomes dark pigmented , prickling , tingling sensation and
discomfort is felt in the breast around 3 to 4 weeks.

18. SKIN
• Pregnant women , varying degrees of pigmentation is observed this is due to
increased activity of the melanin stimulating hormone from pituitary glands.
• Pigmentation on face cheeks , neck , nose called chloasma , symphysis pubis to
xiphisternum called linea nigra , below the umbilicus appear whitish pink streaks
or lines called striae gravidarum.

19. WEIGHT GAIN
• Weight gain during pregnancy : first trimester 1kg , second trimester 5kg , third
trimester 5kg.total weight gain 10 to 12kg during pregnancy.
• Reproductive weight gain
• weight of fetus - 3.3kg , weight of placenta -0.6kg , weight of liquor -0.8kg ,
weight of uterus -0.9kg , weight of breast -0.4kg.

20. NET MATERNAL WEIGHT GAIN
• Increase in blood volume-1.3kg , increase in extracellular fluid -1.2kg ,
accumulation of fat and protein - 3.5kg.
• at the end of maternal weight gain promotes fetal weight gain and the amount of
water retained during pregnancy at term is estimated 6.5liters.

21. HEMATOLOGICAL CHANGES
• the blood volume starts to increase from about 10 th week expands rapidly
thereafter to maximum of 40% above the non pregnant level at 30 - 32 weeks.
• the plasma volume increases during pregnancy this is due to the increased
circulating steroids (estrogen , progesterone , and aldosterone) total plasma
volume increases to the extent of 1.25 liters
• RBC and Hemoglobin :
• The RBC mass is increase to the extent of 20 to 30% the total increase in volume
is about 350ml . This increase is regulated by the increase demand of oxygen
transport during pregnancy .

22. BLOOD COAGULATION FACTORS
• Fibrinogen level is raised by 50%. Fibrinolytic activity is depressed till 15 min after
delivery.
• there is increase in clotting factors X , IV , VIII , VII , II , and decrease in XI and XIII.
These all are effective in control of blood loss after 3rd stage of labour.

23. CARDIOVASCULAR SYSTEM
• Anatomical changes : Due to elevation of the diaphragm consequent to the
enlarge uterus the heart is pushed upward and outward with slight rotation to left
.the apex beat is shifted to the 4 th intercostal space about 2.5 cm outside the
midclavicular line .

24. CARDIAC OUTPUT
• The cardiac output start to increase from 5 th week of pregnancy reaches its peak
40 to 50% at about 30 to 34 weeks , thereafter the cardiac output remain static till
term .Cardiac output lowest in the sitting or supine position and highest in the
right or left lateral .Cardiac output increase further during labour (+50%) and
immediately following delivery(+70%) .there is squeezing out of blood from the
uterus into the maternal circulation (auto transfusion) during labour and in the
immdiate postpartum . cardiac output return to pre labour values y one hour
following delivery and to the pre pranged level by another 4 week .

25. BLADDER
• During early pregnancy due to effect of gravid uterus there occur increased
frequency of urine .
• Renal function :
• The length of kidney is increased by 1cm , glomerular and renal blood flow
increase during pregnancy .

26. GASTRO INTESTINAL SYSTEM
• Increased salivation to be associated with nausea vomiting is relaxation of
smooth muscle of stomach and hypomotility. This nausea vomiting does not
cause any nutritional and electrolyte imbalance . In multiple pregnancy
,hydatidiform mole the pregnant women may experience excessive vomiting that
again due to increased hormone levels .
• The placenta produced hormone progesterone which relax the smooth muscles
of uterus .this hormone also relaxes the valve that separates esophagus from
stomach which can make gastric acid to backflow and causing burning sensation .

27. • The placenta produced hormone progesterone which relax the smooth muscles
of uterus .this hormone also relaxes the valve that separates esophagus from
stomach which can make gastric acid to backflow and causing burning sensation .

28. CHANGES THAT OCCUR IN ENDOCRINE GLAND
DURING PREGNANCY
• The anterior pituitary : during normal pregnancy the anterior pituitary is enlarged
(about twice its normal size) pituitary gonadotrophin level are low due to increase
level of estrogen and progestrone . Growth hormone is elevated . There is
increased TSH level , increase level of anti diuretic hormone , increased level of
oxytocin .

29. THYROID
• Hyperplasia of thyroid gland occurs . Due to increase glomerular filtrate the renal
clearance of iodine is increased

30. HORMONE FOR MAINTENANCE OF LACTATION
• Prolactin by its name means for lactation it is secreted by the chorionic layer of
placenta and the pituitary gland the other name of prolactin .prolactin level high
at term 200 mg /dl .

31. MINOR DISCOMFORTS OF PREGNANCY
• Nausea and vomiting ,urinary urgency and frequency , backache ,constipation ,
leg cramps , acidity , varicose vein , ankle edema , breast tenderness .

32. DIAGNOSIS AND CONFIRMATION OF PREGNANCY
• Positive HCG ,Amenorrhea ,EDD ,morning sickness ,breast discomfort , fatigue,
pre abdomen changes 12 th week felt per abdomen suprapubic bulge

33. SIGN
• cervical changes or goodells sign cervix becomes soft early as 6 th week .
Jacquemier or chadwick sign 8 th week of pregnancy it is the dusky vestibule and
anterior vaginal wall , appears more in multipara . Hegars sign between 6 to 10
weeks upper part of uterus is enlarged by the growing fetus ,lower part is empty
and extremely soft . Palmer sign regular rhythmic uterine contraction early as 4 to
8 weeks .

34. INVESTIGATIONS
• Blood examination of Hb , ABO and Rh grouping and test for VDRL is done .
Urine examination for protein , sugar or pus cell ,USG ,TVS .
• Relationship of fetus to uterus and pelvis : Lie refers to the relationship of the
long axis of the centralized uterus or maternal spine .Longitudinal lie ,oblique lie ,
transverse lie .
• Presentation : the part of the fetus which occupies the lower pole of uterus is
called presentation . The presentation may be cephalic 96.5% , podalic 3% ,
shoulder and other 0.5% .

35. PRESENTING PART
• cephalic presentation : presenting part vertex 96% . Brow or face depending upon
a degree of flexion of head 0.5%. Complete breech ,frank breech , footing
presentation .
• Attitude : flexion
• Position : LOA,ROA,ROP,LOP,ROT.LOTOA,OP

36. PER VAGINAL EXAMINATION
• Vaginal examination is defined as an examination performed per vaginally to
assess the condition /status of vagina , cervix and to note the amount of progress
of descent of fetus through the birth canal .its main purpose is to check the
progress of the labour.