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Ppt pregnancy


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changes during normal pregnancy

Published in: Health & Medicine

Ppt pregnancy

  1. 1. An indication of existance of something/an evidence that is perceptible to physician. •Skin pigmentation •Epulis -4th month •Breast changes •Abdominal enlragement •Uterine shuffle(bruit) •Uterine contractions(Baxton Hicks sign) •Leukorrhea •Pelvic organ changes •Pregnancy test •Auscultaion of fetal heart •Palpation of fetal outline •Recognition of fetal movements •Ultrasonography •Fetal ECG
  2. 2.  Melanocyte stimulating hormone is elevated from early pregnancy. Melanocyte stimultes melanophores in pigmented areas.  Areas already pigmented become more so (nipples, external genitalia and anal region ).  Some fresh pigmentation appears on face CHOLASMA(Gr. Greenish tint of a growing shoot or bud) after 16th week AND on Abdomen as LINEA NIGRA,in most cases after 12th week  STRIAE GRAVIDRUM -are depressed streaks on skin on fat areas (abdomen, breast and thighs) after delivery they regress and persist as STRIAE ALBICANES –they are due to stretching , but may also be associated with increased secretion of ACTH affecting connective tissue
  3. 3. •Hypertrophic gingival papillae are often seen after first trimester of pregnancy. It is also called as pregnancy gingivitis •It mostly occur in mandibular or maxillary areas of gum •It appears in 2nd or 3rd month of 1st trimester •It can arise due to poor oral hygiene •It also occur due to hormonal changes •The gums may become hipertrophic, hiperemic and friable;this maybe due to increased systemic estrogen. •Vitamin C deficiency also can cause tenderness and bleeding of the gums.The gums should return to normal in the early puerperium
  4. 4.  Engorgement of breast after 1st week of pregnancy is caused by:  estrogen –stimulation of mammary duct system and  progesteron -stimulation of alveolar components 6-8 week  Increased vascularity  Sensation of heaviness almost like pain  Nipple and surrounding area become more pigmented(primray aerola)  Montgomery’s tubercles –sebaceous gland which become prominent as raised pink-red nodule on aerola 16 _ 20 week  Clear fluid –clostrum is secreted and may be expressed  Seconadry aerola-a mottles effect due to further
  5. 5. •Protuberance of lower abdomen is usually evident after 14 to 15 week •Reduction in fundal height occurs between 38 to 40 weeks called as LIGHTENING ,it is due to descent of fetus s the lower segment and cervix prepare for labour
  6. 6.  After 16th week, a rushing sound synchronous with mother’s pulse can often be heard bilaterally just above the symphysis  It is due to increased blood flow to the uterus through arteries
  7. 7.  Uterus undergo irregular painless contractions from 9th to 10th week onwards,which become palpable by 20th week  They have no rhythm but become more frequent as pregnancy advances  On bimanual examination irregular uterine contractions may be felt  They are usually not painful in contrast with premature or actual labour •Increased cervical mucous and pronounced exfoliation of vaginal epithelial cells are caused by augmented estrogen ,progesterone levels during pregnancy
  8. 8.  Relaxin hormone loses the pelvic ligaments thus providing space for the fetus passage  The joints and ligaments (fibrous cords and cartilage that connect bones) in the woman's pelvis loosen and become more flexible. This change helps make room for the enlarging uterus and prepare the woman for delivery of the baby. As a result, the woman's posture changes somewhat. OTHER CHANGES.  Softening of tip of cervix by 4th or 5th week Goodel’s sign  Inreased pulsation in lateral fornices by 8th week  Darkening of vaginal skin – Jacquemier’s sign by 8th week
  9. 9. Fetal heart sound can be listen by: •fetoscope •sonicate •CTG •Ultrsound Fetal parts palpation by : •Abdominal examination –after 24 weeks a. Fundal grip b. Lateral grip c. Pelvic/pawlick’s grip Recognition of fetal movement : • Active movements are usually palpable after 18th week • By 16th-18th week passive movements of fetus can be elicited by abdominal and vaginal palpation
  10. 10. •Sound is orderly transmission of mechanical vibrations through a medium •Ultrasound is generated from crystals that have piezoelectric property •If crystal is stimulated it changes its width and generate vibrations that travel into human body •The waves are scattered and reflected back by differences in sound properties between tissue or within tissue •Ultrasound probe(transducer) have many crystals ,the returning echoes to it are reconstructed by the computer and presented as a picture •full bladder is often required for the procedure when abdominal scanning is done in early pregnancy. There may be some discomfort from pressure on the full bladder. The conducting gel is non-staining but may feel slightly cold and wet. There is no sensation at all from the ultrasound waves.
  11. 11. Diagnosis and confirmation of early pregnancy.  The gestational sac can be visualized as early as four and a half weeks of gestation and the yolk sac at about five weeks. The embryo can be observed and measured by about five and a half weeks. Ultrasound can also very importantly confirm the site of the pregnancy is within the cavity of the uterus. Vaginal bleeding in early pregnancy.  The viability of the fetus can be documented in the presence of vaginal bleeding in early pregnancy. A visible heartbeat could be seen and detectable by pulsed doppler ultrasound by about 6 weeks and is usually clearly depictable by 7 weeks. If this is observed, the probability of a continued pregnancy is better than 95 percent. Missed abortions and blighted ovum will usually give typical pictures of a deformed gestational sac and absence of fetal poles or heart beat.  Fetal heart rate tends to vary with gestational age in the very early parts of pregnancy. Normal heart rate at 6 weeks is around 90-110 beats per minute (bpm) and at 9 weeks is 140- 170 bpm. At 5-8 weeks a bradycardia (less than 90 bpm) is associated with a high risk of miscarriage.
  12. 12. Determination of gestational age and assessment of fetal size.  Fetal body measurements reflect the gestational age of the fetus. This is particularly true in early gestation. In patients with uncertain last menstrual periods, such measurements must be made as early as possible in pregnancy to arrive at a correct dating for the patient. The following measurements are usually made: a) The Crown-rump length (CRL) This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 3-4 days of the last menstrual period. An important point to note is that when the due date has been set by an accurately measured CRL, it should not be changed by a subsequent scan. For example, if another scan done 6 or 8 weeks later says that one should have a new due date which is further away, one should not normally change the date but should rather interpret the finding as that the baby is not growing at the expected rate. b) The Biparietal diameter (BPD) The diameter between the 2 sides of the head. This is measured after 13 weeks. It increases from about 2.4 cm at 13 weeks to about 9.5 cm at term. Different babies of the same weight can have different head size, therefore dating in the later part of pregnancy is generally considered unreliable. Dating using the BPD should be done as early as is feasible. c) The Femur length (FL) Measures the longest bone in the body and reflects the longitudinal growth of the fetus. Its usefulness is similar to the BPD. It increases from about 1.5 cm at 14 weeks to about 7.8 cm at term.Similar to the BPD, dating using the FL should be done as early as is feasible. d) The Abdominal circumference (AC) The single most important measurement to make in late pregnancy. It reflects more of fetal size and weight rather than age. Serial measurements are useful in monitoring growth of the fetus. AC measurements should not be used for dating a fetus.
  13. 13. Diagnosis of fetal malformation.  Many structural abnormalities in the fetus can be reliably diagnosed by an ultrasound scan, and these can usually be made before 20 weeks. Common examples include hydrocephalus, anencephaly, myelomeningocoele, achondroplasia and other dwarfism, spina bifida, exomphalos, Gastroschisis, duodenal atresia and fetal hydrops. With more recent equipment, conditions such as cleft lips/ palate and congenital cardiac abnormalities are more readily diagnosed and at an earlier gestational age.  First trimester ultrasonic 'soft' markers for chromosomal abnormalities such as the absence of fetal nasal bone, an increased fetal nuchal translucency (the area at the back of the neck) are now in common use to enable detection of Down syndrome fetuses.  Ultrasound can also assist in other diagnostic procedures in prenatal diagnosis such as amniocentesis, chorionic villus sampling, cordocentesis (percutaneous umbilical blood sampling) and in fetal therapy. 
  14. 14. Placental localization.  Ultrasonography has become indispensible in the localization of the site of the placenta and determining its lower edges, thus making a diagnosis or an exclusion of placenta previa. Other placental abnormalities in conditions such as diabetes, fetal hydrops, Rh isoimmunization and severe intrauterine growth retardation can also be assessed. Multiple pregnancies.  In this situation, ultrasonography is invaluable in determining the number of fetuses, the chorionicity, fetal presentations, evidence of growth retardation and fetal anomaly, the presence of placenta previa, and any suggestion of twin-to-twin transfusion. Hydramnios and Oligohydramnios.  Excessive or decreased amount of liquor (amniotic fluid) can be clearly depicted by ultrasound. Both of these conditions can have adverse effects on the fetus. In both these situations, careful ultrasound examination should be made to exclude intraulterine growth retardation and congenital malformation in the fetus such as intestinal atresia, hydrops fetalis or renal dysplasia. Other areas.  Ultrasonography is of great value in other obstetric conditions such as:  a) confirmation of intrauterine death. b) confirmation of fetal presentation in uncertain cases. c) evaluating fetal movements, tone and breathing in the Biophysical Profile. d) diagnosis of uterine and pelvic abnormalities during pregnancy e.g. fibromyomata and ovarian cyst.
  15. 15. 1st trimester
  16. 16. 2nd trimester
  17. 17. 3rd trimester
  18. 18. Any subjective evidence of diseases or of patient’s condition / such evidence as perceived by the patient.  Amenorrhea  Nausea and vomiting  Increase appetite for pickles n etc—5th month ,28 wk  Pain, cramping in legs at 5 month  Breast tenderness and tingling (discussed earlier)  Stretch marks and linea nigra (discussed earlier)  Increased tiredness  Increase sleep  Fatigue  Urine frequency and urgency  Constipation  Quickening at 16-20 week in primiparas and as early as 14th week in multi paras  Metabolic effectsdue to compensatory mechanism as fetus requirements enhancing day by da  Pedel edema at 6 month relaxin looses ligament  Insomnia at 9th month
  19. 19. Amenorrhea •Conception is usually followed by cessation of menses due to rising titer of HCG Nausea and vomiting •In early months many women suffer gastric upset especially in morning •Cause is unknown but raised level of estrogen n HCG in circulation have been blamed •Gastric motility is reduced due to progesterone , and in early pregnancy the lower esophageal sphincter is relaxed Urine frequency and urgency •Estrogen and progesterone ↑ turgescence of bladder and urethra •Bladder irritability ,nocturia and urine frequency are common in 1st trimester Constipation It is due to : •Changing in food habits •Hormone mediated hypo-active peristalsis(progesteron) •In later pregnancy it is caused by enlarged uterus which
  20. 20. EPULIS Local infection Dental calculus Vitamin C deficiency LACTIFEROUS SECRETIONS Persistent manual breast stimulation Residual fluid from previous pregnancy Galactorrohea ABDOMINAL ENLAGREMENT obesity Relaxation of abdominal muscles Pelvo- abdominal tumor acsitie s Ventral hernia LEUKORRHEA Infection of vagina /cervix Tumor of vagina /cervix Psychically induced excessive cervical mucus CHANGES IN SIZE, SHAPE & COSISTENCY OF CERVIX & UTERUS Premenstural engorgement Uterine tumor Tubo-ovarian cyst Cervic al stenosi s Pyometra
  21. 21. AMENORRHEA Psychic factor Endocrine factor Metabolic factor Asherman’s syndrome Systemic diseases NAUSEA & VOMITING Emotional disorder GIT disorder acute infection BREAST TEND ERNESS Premenstural symptoms Hyper - estrinism Chronic cystic mastitis pseudocysis URINE FREQUENCY UTI cytocele Pelvic tumors Emotional tension ↑use of chocolate QUICKENING Increased peristalsis flatulence Abdominal muscle contractions Shifting abdominal contents
  22. 22. Signs & symptoms Uterine fibroids Ovarian cyst Distended bladder pregnancy Mass consistency Soft hard soft Depend on G/A Pregnancy test -ve -ve -ve +ve Amenorrhea -ve -ve -ve +ve Morning sickness -ve -ve -ve +ve Breast Tenderness ± ± -ve +ve Frequency of micturition ± ± ↓ ↑ Size of abdominal wall ↑ Unequally increase ↑ Enlarge gradually Fetal movement -ve -ve -ve +ve Abdominal tenderness +ve +ve +ve +ve
  23. 23. Weight Gain  Overall gain = ~12.5kg ◦ Foetus = 3.5kg ◦ Placenta = 0.65kg ◦ Uterus = 1kg ◦ Breasts = 0.5kg ◦ Blood and fluid retention = 2kg ◦ Maternal fat = 4kg Cardiovascular Changes Blood volume  Total blood volume increases by 1.5L (40%)  Total plasma volume increases by 1.25L (45%)  Total red blood cell mass increases by between 240ml (18% - without iron supplements) and 400ml (30% - with iron supplements) ◦ Haemocrit falls (40% to 31%) ◦ Haemoglobulin concentration falls from 13.5% to 11-12% ◦ Results in dilutional anaemia of physiological anaemia of pregnancy  White blood cell concentration increases from 7000/ul to 10-11,000/ul  Platelet turnover increases  Total plasma proteins increase, but concentration decreases  Globulin increases, albunin:globulin ratio falls Cardiac Output  Cardiac output increases by approximately 1.5L/min ◦ Stoke volume increases from 64ml to 71ml ◦ Heart rate increases from 70bpm to 85bpm  Total peripheral resistance falls  Blood pressure falls during first trimester, but returns to normal by term Maternal changes during pregnancy
  24. 24. Cardiac distribution  Increased flow to:  uterus (from 50ml/min to 700ml/min, 90% to placenta)  breasts  kidneys (30%)  skin  Venous pressure in lower body increased due to:  mechanical pressure of uterus  haemodynamic effect of increased flow to uterus  veins more distensible (valves weakened) due to progesterone Renal Changes  Increased blood flow (40%)  Increased plasma flow (45%)  Increased glomerular filtration rate (50% - due to increased plasma flow and reduction in colloid osmotic pressure)  Reduced levels of creatine and urea in plasma  Failure to reabsorb all filtered glucose - glycosuria  Amino acid excretion increased  Increased sodium retention (largely due to activation of renal angiotensin system)  Increased water retention  In bladder frequency (both day and night) ◦ Due to increased GFR, compression by uterus and hyperaemia ◦ severe by week 6 then subsides until late pregnancy Respiratory Changes  Minute ventilation increases  Respiratory rate constant  Tidal volume increases - promoted by softening of thoracic ligaments and rising of diaphragm by 4cm  Functional residual volume decreases (reduces dilution of breath)
  25. 25. Gastrointestinal Changes  Progesterone induces cravings  Increased absorption of calcium and iron  lower and upper intestines raised  decreased motility of GIT (increased absorption, but leads to constipation)  reduced tone of lower oesophageal sphincter (due to progesterone, leads to heartburn)  increased volume and contraction of gull bladder (leads to kidney stones) Metabolic Changes  Metabolism increases in general. Changes in:  Carbohydrates (decrease in glucose levels in first trimester, increase in insulin resistance in third trimester due to human placental lactogen - induces metabolism of fat into glycogen which is diffused over placenta, but increases peripheral insulin sensitivity)  Proteins (amino acid concentration falls due to active transport over placenta, require high fibre diet to compensate)  Fat (fatty acids become main energy source and stores increase by 4kg) CHANGES OF SELECTED GLANDS OF THE ENDOCRINE SYSTEM  a. Parathyroid Gland. This gland increases in size slightly. It meets the increased requirements for calcium needed for fetal growth.  b. Posterior Pituitary. Near the end of term, the posterior pituitary will begin to secrete oxytocin that was produced in the hypothalamus and stored there. It will serve to initiate labor.  c. Anterior Pituitary. At birth, the anterior pituitary will begin to secrete prolactin. This stimulates the production of breast milk.  d. Placenta. The placenta acts as a temporary endocrine gland during pregnancy. It produces large amounts of estrogen and progesterone by 10 to 12 weeks of pregnancy. It serves to maintain the growth of the uterus, helps to control uterine activity, and is responsible for many of the maternal changes in the body.
  26. 26. healthy diet good rest proper exercise decrease stress level good care of baby regular visit to doctor are some measures to continue normal pregnancy