The document summarizes the physical changes that occur in a woman's body during pregnancy. It discusses changes to various body systems including cardiovascular, respiratory, endocrine, gastrointestinal and others. It also discusses metabolic changes and increased nutrient needs during pregnancy. Diagnosis of pregnancy is discussed, including presumptive signs like nausea and fatigue, probable signs like missed periods and breast changes, and positive signs like detecting fetal heartbeat, movements and chorionic gonadotropin in urine or blood tests.
Physiological changes during pregnancy can be extensive. The document summarizes several key changes:
1) The uterus grows enormously in size and weight to accommodate the growing fetus. Other genital organs like the cervix and breasts also see significant changes to support pregnancy and birth.
2) Extensive changes occur in many body systems like the cardiovascular, respiratory, urinary and endocrine systems to support the nutritional and oxygen needs of the mother and fetus. This includes increases in blood volume, cardiac output, kidney size and lung capacity.
3) Hormonal changes are also profound, with high levels of progesterone, estrogen and other placental hormones influencing many processes and organs across the body to sustain the pregnancy.
Physiological changes of pregnancy involve changes to support fetal growth. The uterus expands greatly to accommodate the fetus. Other anatomical changes include increased blood volume, softening of ligaments, and breast enlargement. Metabolic changes store fat and protein for the fetus. Cardiovascular changes increase blood volume, cardiac output, and blood pressure. Respiratory changes elevate the diaphragm and increase ventilation. Renal changes increase creatinine clearance. Hormonal changes, like increased progesterone and estrogen, induce these anatomical, metabolic, and physiological adaptations in the mother.
The document summarizes several physiological changes that occur during pregnancy. The uterus enlarges significantly from 30-60 grams to 800-1100 grams due to stretching, hypertrophy, increased tissue, and accumulation of fibrous tissue stimulated by estrogen. The cervix and vagina undergo changes like increased vascularity and thickness. Other systems affected include increased blood volume, cardiovascular changes like lower blood pressure, respiratory changes like increased ventilation, and renal changes like increased glomerular filtration rate. Hormonal changes induce thyroid and adrenal gland enlargement along with increased secretions. Psychological changes can include mood alterations and sleep decreases. The document also briefly outlines metabolic changes like increased weight gain and retention of water and sodium. Pregnancy tests
Physiological changes during pregnancy include:
1. Enlargement of the uterus, cervix, breasts, and other reproductive organs.
2. Increased blood volume, heart rate, and respiration to support the growing fetus and maternal organs.
3. Hormonal changes like increased progesterone and estrogen from the placenta lead to changes in metabolism, immune function, and other systems throughout the body.
Physiological changes in pregnancy include increased blood volume, cardiac output, and respiration. The uterus grows significantly to accommodate the fetus, while other systems like renal and endocrine adapt to support the demands of pregnancy. Diagnosis involves tests to detect hCG in urine or blood from very early pregnancy, and ultrasound to visualize the developing fetus.
Pregnancy causes many anatomical, physiological, and biomechanical changes in the body to support fetal development and birth. The uterus grows enormously over the course of pregnancy. Other systems like cardiovascular, respiratory, and renal systems also adapt to support increased demands on the mother. Hormonal changes induce physical changes in breasts, skin, ligaments and other tissues. Proper understanding of normal pregnancy changes helps healthcare providers manage common issues and risks.
PHYSIOLOGICAL CHANGES DURING PREGNANCY.pdf80DhwaniShah
This document summarizes various physiological changes that occur during pregnancy across multiple body systems. It discusses increased cutaneous pigmentation, breast changes, weight gain, increased blood volume, changes in metabolism of iron, proteins, carbohydrates and lipids, hematological changes including increased red blood cell mass and decreased hematocrit, and immune system modulation away from cytotoxic responses. The document provides detailed information on the timing and extent of changes in each system to support the normal development of the fetus during pregnancy.
During pregnancy, the body undergoes many physiological changes to support the growing fetus. The uterus enlarges significantly in size and weight. The cervix softens and the vagina increases in blood flow. The breasts enlarge and develop features to support lactation. Throughout pregnancy, the cardiovascular and respiratory systems work to increase blood and oxygen supply for the mother and fetus. Hormone levels also change dramatically, with high levels of progesterone, estrogen, and placental hormones that prepare the body for childbirth and breastfeeding.
Physiological changes during pregnancy can be extensive. The document summarizes several key changes:
1) The uterus grows enormously in size and weight to accommodate the growing fetus. Other genital organs like the cervix and breasts also see significant changes to support pregnancy and birth.
2) Extensive changes occur in many body systems like the cardiovascular, respiratory, urinary and endocrine systems to support the nutritional and oxygen needs of the mother and fetus. This includes increases in blood volume, cardiac output, kidney size and lung capacity.
3) Hormonal changes are also profound, with high levels of progesterone, estrogen and other placental hormones influencing many processes and organs across the body to sustain the pregnancy.
Physiological changes of pregnancy involve changes to support fetal growth. The uterus expands greatly to accommodate the fetus. Other anatomical changes include increased blood volume, softening of ligaments, and breast enlargement. Metabolic changes store fat and protein for the fetus. Cardiovascular changes increase blood volume, cardiac output, and blood pressure. Respiratory changes elevate the diaphragm and increase ventilation. Renal changes increase creatinine clearance. Hormonal changes, like increased progesterone and estrogen, induce these anatomical, metabolic, and physiological adaptations in the mother.
The document summarizes several physiological changes that occur during pregnancy. The uterus enlarges significantly from 30-60 grams to 800-1100 grams due to stretching, hypertrophy, increased tissue, and accumulation of fibrous tissue stimulated by estrogen. The cervix and vagina undergo changes like increased vascularity and thickness. Other systems affected include increased blood volume, cardiovascular changes like lower blood pressure, respiratory changes like increased ventilation, and renal changes like increased glomerular filtration rate. Hormonal changes induce thyroid and adrenal gland enlargement along with increased secretions. Psychological changes can include mood alterations and sleep decreases. The document also briefly outlines metabolic changes like increased weight gain and retention of water and sodium. Pregnancy tests
Physiological changes during pregnancy include:
1. Enlargement of the uterus, cervix, breasts, and other reproductive organs.
2. Increased blood volume, heart rate, and respiration to support the growing fetus and maternal organs.
3. Hormonal changes like increased progesterone and estrogen from the placenta lead to changes in metabolism, immune function, and other systems throughout the body.
Physiological changes in pregnancy include increased blood volume, cardiac output, and respiration. The uterus grows significantly to accommodate the fetus, while other systems like renal and endocrine adapt to support the demands of pregnancy. Diagnosis involves tests to detect hCG in urine or blood from very early pregnancy, and ultrasound to visualize the developing fetus.
Pregnancy causes many anatomical, physiological, and biomechanical changes in the body to support fetal development and birth. The uterus grows enormously over the course of pregnancy. Other systems like cardiovascular, respiratory, and renal systems also adapt to support increased demands on the mother. Hormonal changes induce physical changes in breasts, skin, ligaments and other tissues. Proper understanding of normal pregnancy changes helps healthcare providers manage common issues and risks.
PHYSIOLOGICAL CHANGES DURING PREGNANCY.pdf80DhwaniShah
This document summarizes various physiological changes that occur during pregnancy across multiple body systems. It discusses increased cutaneous pigmentation, breast changes, weight gain, increased blood volume, changes in metabolism of iron, proteins, carbohydrates and lipids, hematological changes including increased red blood cell mass and decreased hematocrit, and immune system modulation away from cytotoxic responses. The document provides detailed information on the timing and extent of changes in each system to support the normal development of the fetus during pregnancy.
During pregnancy, the body undergoes many physiological changes to support the growing fetus. The uterus enlarges significantly in size and weight. The cervix softens and the vagina increases in blood flow. The breasts enlarge and develop features to support lactation. Throughout pregnancy, the cardiovascular and respiratory systems work to increase blood and oxygen supply for the mother and fetus. Hormone levels also change dramatically, with high levels of progesterone, estrogen, and placental hormones that prepare the body for childbirth and breastfeeding.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
Physiological changes during pregnancy include changes in the genital organs, breasts, skin, abdomen, blood, metabolism, cardiovascular and urinary systems. The genital organs like the uterus, cervix and breasts enlarge and the blood volume increases significantly. Metabolism increases to support the growth of the fetus. The heart enlarges and cardiac output increases. Kidney function is enhanced and urinary frequency rises, especially later in pregnancy. Respiration is also impacted with higher oxygen needs.
Physiological changes during pregnancy can be extensive. The uterus grows dramatically in size and the cervix softens. The breasts enlarge and darken. Throughout pregnancy, the body retains more fluid and blood volume increases. Respiration increases to support higher oxygen needs. The heart works harder pumping more blood. The kidneys and liver increase in size. Many hormonal changes prepare the body for childbirth and nurturing a baby.
The document describes the physiological changes that occur during pregnancy across multiple body systems. Some key changes include:
- The uterus increases greatly in size and shifts positions as pregnancy progresses. Other pelvic organs also experience hypertrophy.
- The cardiovascular system works to accommodate the increased blood volume, with cardiac output and stroke volume rising.
- Respiratory changes include elevated diaphragm and increased ventilation to support higher oxygen needs.
- The urinary system adapts to pregnancy through dilated structures but is more prone to infections.
- Hormonal changes influence metabolism, immunity, skin, breasts and multiple other systems.
The document discusses the various physiological changes that occur during pregnancy. Key changes include fluid retention leading to increased blood volume and decreased blood pressure. The heart works harder with increased heart rate, stroke volume and cardiac output. Hormonal changes impact multiple systems and prepare the body for childbirth and lactation. The kidneys filter more waste and the immune system is suppressed to tolerate the fetus. Overall, the body undergoes many adaptations to support the growing fetus.
Physiological and psychological changes during pregnancyhanges [Recovered].pptxMonikaKosre
Physiological and Psychological changes during pregnancy
The document discusses the extensive anatomical, physiological, and biochemical changes that occur throughout a woman's body during pregnancy. These changes prepare the mother's body to support the growing fetus and include increases in blood volume, cardiovascular function, temperature regulation, kidney and liver function, as well as changes in the skin, reproductive organs, breasts, and other systems. The purpose of these changes is to create a healthy environment for fetal development without compromising the mother's health.
Physiological changes during pregnancyDeepa Mishra
PHYSIOLOGICAL CHANGES DURING PREGNANCY
Deepa Mishra
Assistant Professor (OBG)
Pregnancy
Pregnancy usually occurs during 15-44 yrs of a woman.
Duration of pregnancy from LMP is 280 days or 40 weeks or 9 months and 7 days
Three trimester-
1st Trimester -0 -12 weeks
2nd trimester – 13-28 weeks
3rd trimester -29-40 weeks s
Physiological changes
Reproductive system
Hematological and Cardiovascular changes
Respiratory, Acid base balance, electrolyte changes
Urinary changes
GI changes
Metabolic changes
Skeletal and neurological changes
Skin changes
Endocrinal changes
Psychological changes
The document discusses various physiological changes that occur during pregnancy including changes to body water metabolism, cardiovascular system, respiratory system, hematologic system, endocrine system, and other organ systems. It also discusses conditions like intrauterine growth restriction (IUGR) and hypertension that can arise during pregnancy. IUGR is defined as birth weight below the 10th percentile and can be symmetrical or asymmetrical. Hypertension in pregnancy includes chronic hypertension, gestational hypertension, and preeclampsia.
Laura is 34 weeks pregnant and experiencing common discomforts of late pregnancy like heartburn, diarrhea/constipation, edema, and fatigue. Her hematocrit is 31%, which is within the normal range for pregnancy.
During pregnancy, the placenta secretes hormones like hCG, estrogen, progesterone, and others that prepare the body for pregnancy and support fetal development. This causes physiological changes in many body systems. The uterus and breasts enlarge, blood volume increases, and the metabolism and respiration rates rise to meet increased demands. These changes help the fetus receive nutrients and oxygen from the mother.
PHYSIOLOGICAL and BIOCHEMICAL CHANGES AND NUTRIENT NEEDS OF PREGNANT LADYSakshi Singla
Physiological and biochemical changes occur in a pregnant woman's body to support the growth and development of the fetus. The woman's respiratory, cardiovascular, and endocrine systems undergo adaptations to meet increased demands. Nutrient needs are also altered to support the woman's health and the fetus's growth. Inadequate nutrition during pregnancy can harm both mother and baby, potentially leading to complications like anemia, preterm birth, or birth defects. A balanced diet with sufficient calories, proteins, vitamins, and minerals is important for supporting the pregnancy.
This document summarizes many of the physiological changes that occur during pregnancy across multiple body systems. Some key changes include increased blood volume and cardiac output, respiratory changes like elevated diaphragm and decreased lung capacity, hormonal changes involving thyroid and adrenal function, urinary and digestive changes, and skin changes like hyperpigmentation. Pregnancy results in major adaptations to the mother's anatomy, physiology, and metabolism to support the development of the fetus.
Physiological changes during pregnancy allow the mother's body to support fetal growth and development. The cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems undergo remodeling. The cardiovascular system increases blood volume and cardiac output by 40% by the third trimester. Respiration increases to meet higher oxygen needs. Hormonal changes, like increased progesterone and estrogen, prepare the uterus and breasts for birth. Overall, the adaptations sustain a healthy environment for the fetus throughout pregnancy.
Physiological changes during pregnancy allow the mother's body to support fetal growth and development. The cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems undergo remodeling. The cardiovascular system increases blood volume and cardiac output by 40% by the third trimester. The respiratory system compensates for increased oxygen needs through hyperventilation. Hormonal changes, like increased estrogen and progesterone, prepare the breasts, uterus, and other organs for childbirth. These adaptations maintain a healthy environment for the developing fetus.
Physiology of Pregnancy for Undergraduatesthezaira
The document summarizes the physiological changes that occur throughout a woman's body during pregnancy. Key changes include enlargement and increased blood flow to the uterus, breasts, and major organs. Other changes are weight gain and fluid retention, increased blood volume and altered metabolism to support the growing fetus. The various body systems also adapt to pregnancy through respiratory alkalosis, circulatory adjustments and neurological/hormonal responses.
This document discusses nutrition during pregnancy. It begins by defining key terms like conception, gestation, embryo, fetus, and parturition. It then discusses factors that can contribute to intrauterine growth restriction like inadequate maternal nutrition. The physiological stages of pregnancy are explained, along with maternal physiological adjustments and changes in various body systems. Nutritional requirements are increased during pregnancy to meet demands of the growing fetus and maternal tissues. Recommended increases in energy and specific nutrients are provided. The rationale for increasing requirements of certain nutrients like protein and vitamin A is explained.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
The document provides an overview of the physiological changes that occur throughout the maternal body during pregnancy. Key changes discussed include:
- Uterine growth and changes to support fetal development.
- Increased cardiac output, blood volume, and vascular changes to support nutrient/waste exchange between mother and fetus.
- Respiratory changes like increased tidal volume to support oxygen demands.
- Renal changes like increased GFR and kidney size to excrete wastes and support calcium/electrolyte balance.
- Metabolic changes to support fetal growth including increased lipids, proteins, and iron.
- Skin changes like line striae and pigmentation due to hormonal influences.
- Central nervous
- During pregnancy, the female body undergoes many physiological changes to support the growing fetus. These include changes in the genital organs, breasts, skin, weight gain, fluid balance, blood volume, cardiovascular and respiratory systems, metabolism, and hormones. The endocrine system works to regulate these changes through increased levels of progesterone, estrogen, cortisol and other hormones produced by the ovaries, placenta, and pituitary gland. These changes help create a favorable environment for the fetus to develop over the course of the pregnancy.
Precision or personalized medicine uses a person's genes or proteins to prevent, diagnose or treat disease. Biomarkers like genes, proteins, metabolites can be analyzed from "omics" data to understand patients. All a patient's clinical and genomic data should be stored together. Precision medicine in the ICU considers individuals rather than just their condition. Studies explore using genetics to understand diseases like heart disease, atrial fibrillation, kidney injury and sepsis. Goals are developing personalized treatment, like optimizing hemodynamics based on cardiac models incorporating a person's unique features. Precision medicine raises ethics issues around consent for using genetic data but its benefits are promising. The future of precision medicine in the ICU looks to further apply genetics to improve patient
Asthma and allergic rhinitis were discussed. Koumail Yassine, a 5th year medical student, gave a presentation on clinical immunology focusing on these conditions. Both asthma and allergic rhinitis involve an allergic response that causes inflammation in the respiratory tract.
Maternal physiological changes in pregnancy are the adaptations during pregnancy that a woman's body undergoes to accommodate the growing embryo or fetus. ... The pregnant woman and the placenta also produce many other hormones that have a broad range of effects during the pregnancy.
Physiological changes during pregnancy include changes in the genital organs, breasts, skin, abdomen, blood, metabolism, cardiovascular and urinary systems. The genital organs like the uterus, cervix and breasts enlarge and the blood volume increases significantly. Metabolism increases to support the growth of the fetus. The heart enlarges and cardiac output increases. Kidney function is enhanced and urinary frequency rises, especially later in pregnancy. Respiration is also impacted with higher oxygen needs.
Physiological changes during pregnancy can be extensive. The uterus grows dramatically in size and the cervix softens. The breasts enlarge and darken. Throughout pregnancy, the body retains more fluid and blood volume increases. Respiration increases to support higher oxygen needs. The heart works harder pumping more blood. The kidneys and liver increase in size. Many hormonal changes prepare the body for childbirth and nurturing a baby.
The document describes the physiological changes that occur during pregnancy across multiple body systems. Some key changes include:
- The uterus increases greatly in size and shifts positions as pregnancy progresses. Other pelvic organs also experience hypertrophy.
- The cardiovascular system works to accommodate the increased blood volume, with cardiac output and stroke volume rising.
- Respiratory changes include elevated diaphragm and increased ventilation to support higher oxygen needs.
- The urinary system adapts to pregnancy through dilated structures but is more prone to infections.
- Hormonal changes influence metabolism, immunity, skin, breasts and multiple other systems.
The document discusses the various physiological changes that occur during pregnancy. Key changes include fluid retention leading to increased blood volume and decreased blood pressure. The heart works harder with increased heart rate, stroke volume and cardiac output. Hormonal changes impact multiple systems and prepare the body for childbirth and lactation. The kidneys filter more waste and the immune system is suppressed to tolerate the fetus. Overall, the body undergoes many adaptations to support the growing fetus.
Physiological and psychological changes during pregnancyhanges [Recovered].pptxMonikaKosre
Physiological and Psychological changes during pregnancy
The document discusses the extensive anatomical, physiological, and biochemical changes that occur throughout a woman's body during pregnancy. These changes prepare the mother's body to support the growing fetus and include increases in blood volume, cardiovascular function, temperature regulation, kidney and liver function, as well as changes in the skin, reproductive organs, breasts, and other systems. The purpose of these changes is to create a healthy environment for fetal development without compromising the mother's health.
Physiological changes during pregnancyDeepa Mishra
PHYSIOLOGICAL CHANGES DURING PREGNANCY
Deepa Mishra
Assistant Professor (OBG)
Pregnancy
Pregnancy usually occurs during 15-44 yrs of a woman.
Duration of pregnancy from LMP is 280 days or 40 weeks or 9 months and 7 days
Three trimester-
1st Trimester -0 -12 weeks
2nd trimester – 13-28 weeks
3rd trimester -29-40 weeks s
Physiological changes
Reproductive system
Hematological and Cardiovascular changes
Respiratory, Acid base balance, electrolyte changes
Urinary changes
GI changes
Metabolic changes
Skeletal and neurological changes
Skin changes
Endocrinal changes
Psychological changes
The document discusses various physiological changes that occur during pregnancy including changes to body water metabolism, cardiovascular system, respiratory system, hematologic system, endocrine system, and other organ systems. It also discusses conditions like intrauterine growth restriction (IUGR) and hypertension that can arise during pregnancy. IUGR is defined as birth weight below the 10th percentile and can be symmetrical or asymmetrical. Hypertension in pregnancy includes chronic hypertension, gestational hypertension, and preeclampsia.
Laura is 34 weeks pregnant and experiencing common discomforts of late pregnancy like heartburn, diarrhea/constipation, edema, and fatigue. Her hematocrit is 31%, which is within the normal range for pregnancy.
During pregnancy, the placenta secretes hormones like hCG, estrogen, progesterone, and others that prepare the body for pregnancy and support fetal development. This causes physiological changes in many body systems. The uterus and breasts enlarge, blood volume increases, and the metabolism and respiration rates rise to meet increased demands. These changes help the fetus receive nutrients and oxygen from the mother.
PHYSIOLOGICAL and BIOCHEMICAL CHANGES AND NUTRIENT NEEDS OF PREGNANT LADYSakshi Singla
Physiological and biochemical changes occur in a pregnant woman's body to support the growth and development of the fetus. The woman's respiratory, cardiovascular, and endocrine systems undergo adaptations to meet increased demands. Nutrient needs are also altered to support the woman's health and the fetus's growth. Inadequate nutrition during pregnancy can harm both mother and baby, potentially leading to complications like anemia, preterm birth, or birth defects. A balanced diet with sufficient calories, proteins, vitamins, and minerals is important for supporting the pregnancy.
This document summarizes many of the physiological changes that occur during pregnancy across multiple body systems. Some key changes include increased blood volume and cardiac output, respiratory changes like elevated diaphragm and decreased lung capacity, hormonal changes involving thyroid and adrenal function, urinary and digestive changes, and skin changes like hyperpigmentation. Pregnancy results in major adaptations to the mother's anatomy, physiology, and metabolism to support the development of the fetus.
Physiological changes during pregnancy allow the mother's body to support fetal growth and development. The cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems undergo remodeling. The cardiovascular system increases blood volume and cardiac output by 40% by the third trimester. Respiration increases to meet higher oxygen needs. Hormonal changes, like increased progesterone and estrogen, prepare the uterus and breasts for birth. Overall, the adaptations sustain a healthy environment for the fetus throughout pregnancy.
Physiological changes during pregnancy allow the mother's body to support fetal growth and development. The cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems undergo remodeling. The cardiovascular system increases blood volume and cardiac output by 40% by the third trimester. The respiratory system compensates for increased oxygen needs through hyperventilation. Hormonal changes, like increased estrogen and progesterone, prepare the breasts, uterus, and other organs for childbirth. These adaptations maintain a healthy environment for the developing fetus.
Physiology of Pregnancy for Undergraduatesthezaira
The document summarizes the physiological changes that occur throughout a woman's body during pregnancy. Key changes include enlargement and increased blood flow to the uterus, breasts, and major organs. Other changes are weight gain and fluid retention, increased blood volume and altered metabolism to support the growing fetus. The various body systems also adapt to pregnancy through respiratory alkalosis, circulatory adjustments and neurological/hormonal responses.
This document discusses nutrition during pregnancy. It begins by defining key terms like conception, gestation, embryo, fetus, and parturition. It then discusses factors that can contribute to intrauterine growth restriction like inadequate maternal nutrition. The physiological stages of pregnancy are explained, along with maternal physiological adjustments and changes in various body systems. Nutritional requirements are increased during pregnancy to meet demands of the growing fetus and maternal tissues. Recommended increases in energy and specific nutrients are provided. The rationale for increasing requirements of certain nutrients like protein and vitamin A is explained.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
During pregnancy, the female body undergoes many physiological changes to support the growing fetus. The genital organs like the uterus, cervix, and breasts enlarge and the vascularity increases. The cardiovascular system works harder - blood volume, heart rate, and cardiac output increase. Respiration also increases to supply more oxygen to the mother and fetus. Hormonal changes driven by the placenta result in further physical adaptations like skin pigmentation and breast development. These changes help create a healthy environment for the baby to develop over the 9 months of pregnancy.
The document provides an overview of the physiological changes that occur throughout the maternal body during pregnancy. Key changes discussed include:
- Uterine growth and changes to support fetal development.
- Increased cardiac output, blood volume, and vascular changes to support nutrient/waste exchange between mother and fetus.
- Respiratory changes like increased tidal volume to support oxygen demands.
- Renal changes like increased GFR and kidney size to excrete wastes and support calcium/electrolyte balance.
- Metabolic changes to support fetal growth including increased lipids, proteins, and iron.
- Skin changes like line striae and pigmentation due to hormonal influences.
- Central nervous
- During pregnancy, the female body undergoes many physiological changes to support the growing fetus. These include changes in the genital organs, breasts, skin, weight gain, fluid balance, blood volume, cardiovascular and respiratory systems, metabolism, and hormones. The endocrine system works to regulate these changes through increased levels of progesterone, estrogen, cortisol and other hormones produced by the ovaries, placenta, and pituitary gland. These changes help create a favorable environment for the fetus to develop over the course of the pregnancy.
Precision or personalized medicine uses a person's genes or proteins to prevent, diagnose or treat disease. Biomarkers like genes, proteins, metabolites can be analyzed from "omics" data to understand patients. All a patient's clinical and genomic data should be stored together. Precision medicine in the ICU considers individuals rather than just their condition. Studies explore using genetics to understand diseases like heart disease, atrial fibrillation, kidney injury and sepsis. Goals are developing personalized treatment, like optimizing hemodynamics based on cardiac models incorporating a person's unique features. Precision medicine raises ethics issues around consent for using genetic data but its benefits are promising. The future of precision medicine in the ICU looks to further apply genetics to improve patient
Asthma and allergic rhinitis were discussed. Koumail Yassine, a 5th year medical student, gave a presentation on clinical immunology focusing on these conditions. Both asthma and allergic rhinitis involve an allergic response that causes inflammation in the respiratory tract.
The document discusses the anatomy and function of the glutes, thighs, and lower legs. It describes the three main gluteal muscles - gluteus maximus, medius, and minimus - and their roles in hip extension and abduction. It outlines the nerves that innervate the muscles of the lower body and explains how injuries to these nerves, such as from fractures or disc herniations, can impact muscle function. The document also reviews common injuries like ankle sprains and discusses anatomical structures like the sciatic nerve branches.
Alpha 1 Antitrypsin Deficiency leads to Chronic Obstructive Pulmonary Disease (COPD) or emphysema of the lungs due to a buildup of improperly folded alpha 1 antitrypsin protein in the liver which cannot be secreted. This prevents the protein from protecting the lungs from neutrophil elastase, causing lung tissue destruction. The most common variant in the U.S. is the S variant which results from a point mutation replacing glutamic acid with lysine at position 342, causing the protein to fold abnormally and lose its function to inhibit neutrophil elastase in the lungs and protect liver tissue from damage.
This document provides guidelines for the management of patients with valvular heart disease (VHD). It discusses diagnostic testing and follow up for patients with VHD, including echocardiograms to monitor asymptomatic patients based on the type and severity of their valve lesion. It also provides tables on the stages of VHD, secondary prevention of rheumatic fever with recommended treatment regimens and durations, and additional diagnostic testing that may be required before valve interventions. The guidelines establish classifications and levels of evidence for clinical recommendations.
This document provides information about asthma and how to provide first aid for an asthma attack. It defines asthma as a condition where the air passages in the lungs can spasm and narrow, making breathing difficult. Signs of an asthma attack include wheezing, difficulty breathing, and anxiety. To treat an asthma attack, one should help the person sit down, encourage slow breathing, assist them in using their reliever inhaler if available, and call for emergency help if the attack does not ease in a few minutes. Common triggers for asthma attacks include pollen, pollution, pet fur, smoking, aerosols, cold air, exercise, and cleaning solutions.
Genetic characteristics such as atopy, which is a predisposition to develop antibodies to environmental allergens, and environmental exposures increase the risk of developing asthma. A 2000 report from the Institute of Medicine reviewed evidence on indoor air exposures and asthma, finding sufficient evidence that house dust mites and environmental tobacco smoke causally increase asthma risk and exacerbation, especially in children. Cockroaches were also associated with increased asthma risk in preschoolers.
This document appears to be a template for a presentation about animals. It includes sections on elephants, cats, dogs, pandas, kangaroos, and koalas. Facts provided include that elephants can sense storms from far away, cats use their whiskers to determine if they can fit through spaces, and dogs can smell human emotions. The presentation emphasizes providing interesting facts and encourages customizing the slides by replacing images and text.
1) Intrauterine growth restriction and fetal distress can occur due to issues with the placenta such as hypoplasia (weight less than 500g), defects in development, or blood circulation problems from hemorrhage, edema, thrombosis or infarction.
2) Diagnosis involves monitoring the fetal heart rate through auscultation during pregnancy and labor as well as additional tests like biophysical profile, Doppler ultrasound of the umbilical artery, and cardiotocography during labor.
3) Treatment involves addressing any maternal health issues, close fetal monitoring, and emergency cesarean delivery if worsening blood flow or certain abnormal heart rate patterns on monitoring are observed.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. ► Changes in the organism
of the pregnant woman
are subordinated to one
central objective - normal
development of embryo
and fetus
3. Influence of embryo on the homeostasis
of pregnant woman
► Cardiovascular
system
► Secretory system
► Digestive system
► Central and
peripheral
nervous system
► Endocrine
system
► Basal
metabolism
► Skin and it’s
appendages
► Skeleton and the
bone system
► Immune system
4. Endocrine function of the
trophoblast
Early diagnostics of pregnancy is
based on determination of
chorionic gonadotropin in blood
and urine
► chorionic gonadotropin appears in the blood of
pregnant females from 2nd -3rd week of gestatuon,
which stimulates the function of “yellow body of
pregnancy” till 3rd month of gestation
5. Endocrine function of the trophoblast
►chorionic gonadotropin
►estradiol and estriol
►placental somatomammotropin
►progesteron
►thyrotropic hormone
►insulin-like factor
►STG and ACTH
►renin
►Angiotensin
►etc.
7. Endocrine changes
► in 35-40% of pregnant women
thyroid gland is enlarged due to
increasing of follicles number
and their hyperplasia
► in the first months of pregnancy
increasing of thyroid gland
function is noted
► in the second-half of pregnancy
it’s hypofunction sometimes
appears
Thyroid gland
9. The mammary glands
► Increase in lobules size and
volume of the mammary
glands
► The number of alveoli and
lactiferrous ducts increases
► Significant increase of fat
tissue quantity
► By the end of the pregnancy
the colostrum (under the
effect of the prolactin) is
produced
10. Uterus
► Increase in the mass of womb from 50-60 g up to 1000 g
by the end of pregnancy
► Lengthening of separate muscular fibers in 15 times
► Increase of vascularization
► Softening of the cervix and it’s cyanosis
► Reduction of vaginal pH
11. Covers of the body
► Stretching of abdominal wall
► Abundant deposits of fat on
pubis, buttocks and mammary
glands
► Pigmentation of the skin (by
melanin)
► Stria gravidarum
► Varicose veins
► Smoothing and protrusion of
the umbilicus
12. Skeleton
► Change in the center of gravity - proud gait
of the pregnant females
► Widening of the lower aperture of the chest
► Loosening of the cartilages
► Divergence of pubic branches to the sides up
to 2 cm
13. Changes in the central nervous system
► Reduction of cortex irritabiliity during
the first 3-4 months of pregnancy and
an increase in the irritabiliity after 4
months of pregnancy
cortex
14. Changes in nervous system
► Changes of the tone
vegetative system
1. sleepiness
2. unbalanced state
3. change of mood
4. change in the taste
5. hypersalivation
6. vomiting
7. tendency to the vertigo
Limbic system
15. Changes of the cardiovascular
system
► increase of heart rate (10-20%)
► increase in the cardiac output
(10%)
► increase of the volume of
circulating blood
► physiological hypertrophy of the
left ventricle
16. Changes of the cardiovascular
system
► decrease of average BP
(10%)
► reduction in general
peripheral vascular resistance
(35%)
► hypotensive syndrome 15%
► disturbance of venous return
to the heart in the position of
pregnant on the back
18. Hematologic changes
DECREASE
► number of erythrocytes
► level of hemoglobin
► value of hematocrit
► concentration of folic acid in the
plasma
INCREASE
► number of leukocytes
► ESR
► concentration of fibrinogen
19. Changes in the lungs ventilation
► change in the anatomy of chest
► increased respiratory volume
► increased respiratory rate (10%) -
contributes to the establishment of the
lower partial pressure of carbon dioxide
(pCO2)
► hyperventilation
► increased oxygen intake by maternal
organism and growing fetus
20. Changes in the gases of the
arterial blood
► Reduction in pCO2 (on 15-20%) -
contributes to the passage of
carbonic acid dioxide of the fetus
through the placenta
► increase in pO2
► increase in the delivery of oxygen to
tissues
► increase in the excretion of
bicarbonates
21. Volume of liquid in the organism
► Delay of liquid (from 8 to 10 kg of
the body mass)
Factors, which facilitate the delay of
the liquid
► Delay of sodium chloride in the
tissues
► reconstruction of osmoregulation
(increase of ACTH and
mineralocorticoids)
► reduction of the thirst threshold
► decrease of oncotic pressure in
plasma
22. Consequences of the liquid delay
► Decrease in the level of
hemoglobin
► reduction of hematocrit value
► reduction of albumin
concentration in the plasma
► increased cardiac output
► increase of kidneys blood flow
23. Changes in the function of the kidneys
► the extension of renal pieli
► disturbance of tone and contracting
ability of muscles of minor renal
calyces and urethras
► increase nephritic blood flow (60-
75%)
► increase filtration (50%)
► acceleration of the clearance of the
majority of substances
► glucosuria serves as the version of
the standard
24. Gastrointestinal tract
During the pregnancy:
► rises appetite
► increases a quantity of
eaten food
► it is strengthened the
function of all digestive
glands
► it is activated
exchange of
substances
25. Gastrointestinal tract
► a decrease and the
distortion of taste
► Is reduced stomachic
acidity
► is lowered the tone of
stomach and its
evacuatory capability -
doubly the hypotonia
of bowels
► haemorrhoid
26. Gastrointestinal tract
► Is strengthened the blood
circulation of the liver
► is lowered antitoxic function
► in the end of the pregnancy
the liver it displaces upward
and toward the rear due to
the growing uterus
Liver
27. Metabolism
► Increase of the mass of body on
the average to 9-10 kg to the
40th week of the pregnancy:
► the mass of fetus - 3300 g
► the mass of placenta - 650 g
► the mass of amniotic liquid - 800
g
► the mass of increased uterus -
900 g
► 3-5 days prior to the labor the addition of the mass of body
stops in view of the reducing of an increase fetus weight,
partial suction of amniotic waters and regressive changes in the
placenta
28. Metabolism
► basal metabolism rises by 20%
► the pregnant woman of medium
height (155-165 cm) and with the
average mass of body (55-65 kgf)
with the easy muscular work must
obtain in the average 3000-3200
kcal during the day
► he need for the additional energy
is 150 kcal during the day in the
first and on 350 kcal during the
day in the second and third terms
of the pregnancy
29. Metabolisms
► strengthening plastic
processes in the organism
(predominance of the
processes of assimilation
above the processes of
dissimilation
► the daily need for the basic
forms of the nourishment:
proteins - 110-120 g
carbohydrates - 300-400 g
fats - 75-83 g
30. Protein metabolism
► The activation of anabolic
hormones leads to
strengthening of the
synthesis of ribonucleic
acid (RNA), which causes
an increase in the
synthesis of proteins, in
particular ferments, in the
ribosomes
31. Metabolism. Proteins
► A deficiency in the proteins in the diet of pregnant
females leads to the development:
1. the heavy forms of preeclmpsia and eclampsia
2. anemia
3. vomiting
4. worsening in the flow of the hypertensive syndrome
► To every 100 g of the proteins, eaten by mother, approximately
1 g enter to fetus
► Need of pregnant female for the proteins - 1,5 g on 1 kg of the
mass of body during the day
32. The valuable proteins, in which the products of
the animal origin, are rich are especially
recommended by pregnant female:
► boiled meat
► egg
► milk
► cheese
► cottage cheese
► fish
The proteins of plant origin must not exceed 50% of
total quantity of proteins of those entering the
organism of pregnant female with the food
33. Metabolism.
FATS
Changes in the fat metabolism during
pregnancy it is evinced by the increased
assimilation of fats with reduction in the
process of their oxidation, which leads to:
► to accumulation in the blood of ketosis bodies,
and acetoacetic acid
► to an increase of the deposit of fat in different
organs and tissues (the adrenal glands, the
placenta, in the breast glands)
34. Metabolism.
FATS
The consumption of fats during pregnancy
must be limited - in average 1,5 g on 1 kg of
the mass of body during the day
► Better to use the fusible fats, which are
contained in the milk and the dairy products
(cream, sour cream, butter, cheeses), and also
vegetable oils
The complete limitation of fats is undesirable, since the fat-
soluble vitamins, which play important role in the development
of the fetus enter with them into the organism
35. Metabolism
CARBOHYDRATES
► Lability of the content of
sugar in the blood
(certain of its increase in
higher than the limits of
physiological standard)
► Periodic appearance of
sugar in the urine
(strengthening the
permeability of nephritic
epithelium)
36. Metabolism
CARBOHYDRATES
► With the food the pregnant female must consume during the
day of 350-400 g of the carbohydrates, in which the products
of the plant origin: bread, sugar, groats, vegetables, fruits
► From the animal products only milk contains the
carbohydrates in the form of milk sugar (lactose)
► Major portion of the carbohydrates in the food ration must
compose polysaccharides - starch, which, being slowly split
and being mastered, lengthens the period of saturation and
coating power expenditures simultaneously
► The increased use of carbohydrates with pregnant
woman leads to a sharp increase in the mass of fetus
body (4 kg and more)
37. Vitamins and minerals
► The increased need of the
vitamins and the
microelements is observed
during pregnancy, because for
the normal increase and
development of fetus it is
insufficient entering from the
maternal organism of oxygen,
proteins, fats, carbohydrates
and water; be required even
complementary factors for the
cellular metabolism - vitamins
and minerals
38. DIAGNOSIS OF PREGNANCY
► The endocrinological, physiological,
and anatomical alterations that
accompany pregnancy give rise to
symptoms and signs that provide
evidence that pregnancy exists.
These symptoms and signs are
classified into three groups:
► presumptive evidence
► probable signs
► positive signs of pregnancy
39. PRESUMPTIVE EVIDENCE OF
PREGNANCY
► 1. Nausea with or without vomiting.
This so-called morning sickness of pregnancy usually commences
during the early part of the day but passes in a few hours,
although occasionally it persists longer and may occur at other
times.
This disturbing symptom usually begins about 6 weeks after the
commencement (first day) of the last menstrual period, and
ordinarily disappears spontaneously 6 to 12 weeks later.
The cause of this disorder is unknown but seems to be associated
with higher levels of selected forms of hCG (variations in
glycosylation) with the greatest thyroid-stimulating capacity.
Chorionic gonadotropin, especially isoforms with relatively
diminished amounts of sialic acid, act via the thyroid-stimulating
hormone (TSH) receptor to accelerate iodine uptake
40. 2. Disturbances in urination.
► During the first trimester, the
enlarging uterus, by exerting
pressure on the urinary bladder,
may cause frequent micturition.
41. 3. Fatigue
► Easy fatigability is such
a frequent
characteristic of early
pregnancy that it
provides a noteworthy
diagnostic clue.
42. Probable signs
► 1. Cessation of menses. The abrupt cessation of menstruation in a
healthy reproductive-age woman who previously has experienced
spontaneous, cyclical, predictable menses is highly suggestive of
pregnancy. There is appreciable variation in the length of the ovarian
(and thus menstrual) cycle among women, and even in the same woman.
It is not until 10 days or more after the time of expected onset of the
menstrual period, therefore, that the absence of menses is a reliable
indication of pregnancy. When a second menstrual period is missed, the
probability of pregnancy is much greater.
► 2. Changes in the breasts.
► 3. Discoloration of the vaginal mucosa. During pregnancy, the vaginal
mucosa usually appears dark bluish or purplish-red and congested; this is
the so-called Chadwick sign
► 4. Increased skin pigmentation and the development of abdominal striae.
43. Probable signs
► 5. Enlargement of the abdomen.
► 6. Changes in the shape, size, and consistency of the
uterus.
► 7. Anatomical changes in the cervix.
► 8. Braxton Hicks contractions. During pregnancy, the
uterus undergoes palpable but ordinarily painless
contractions at irregular intervals from the early stages of
gestation. These contractions, referred to as Braxton Hicks
contractions, may increase in number and amplitude when
the uterus is massaged.
44. Positive signs of pregnancy
► 1. Identification of fetal heart action separately
and distinctly from that of the pregnant woman.
► 2. Perception of active fetal movements by the
examiner.
► 3. Recognition of the embryo and fetus any time
in pregnancy by sonographic techniques or of the
more mature fetus radiographically in the latter
half of pregnancy.
► 4. Detection of chorionic gonadotropin.
45. Positive signs of pregnancy
►DETECTION OF CHORIONIC
GONADOTROPIN. The presence of chorionic
gonadotropin (hCG) in maternal plasma and
its excretion in urine provides the basis for
the endocrine tests for pregnancy. This
hormone can be identified in body fluids by
any one of a variety of immunoassay or
bioassay techniques.
46. ► FETAL HEART ACTION. Hearing or observing the
pulsations of the fetal heart assures the diagnosis
of pregnancy. Fetal heart contractions can be
identified by auscultation with a special fetoscope,
by use of the Doppler principle with ultrasound,
and by sonography.
47. The fetal heartbeat
► can be detected by auscultation with a
stethoscope by 17 weeks, on average,
and by 19 weeks in nearly all
pregnancies in non-obese women. The
fetal heart rate at this stage and beyond
ranges from 120 to 160 bpm and is
heard as a double sound resembling the
tick of a watch under a pillow.
48. PERCEPTION OF FETAL
MOVEMENTS.
► Detection by the examiner of fetal movements can
occur after about 20 weeks. Fetal movements vary
in intensity from a faint flutter early in pregnancy
to brisk motions at a later period; the latter are
sometimes visible as well as palpable.
Occasionally, somewhat similar sensations may be
produced by contractions of the abdominal
muscles or intestinal peristalsis, although these
should not deceive an experienced examiner.
49. ULTRASONIC RECOGNITION OF
PREGNANCY.
► The use of transvaginal sonography has
revolutionized imaging of early pregnancy and its
growth and development. A gestational sac may be
demonstrated by abdominal sonography after only 4
to 5 weeks' menstrual age. By 35 days, all normal
sacs should be visible, and after 6 weeks, a
heartbeat should be detectable. By 8 weeks, the
gestational age can be estimated quite accurately.
Up to 12 weeks, the crown-rump length is predictive
of gestational age within 4 days.
50. PROCEDURES FOR PRENATAL CARE
The American Academy of Pediatrics and the American
College of Obstetricians and Gynecologists (1997) have
defined prenatal care as follows:
"A comprehensive antepartum care program that involves a
coordinated approach to medical care and psychosocial
support that optimally begins before conception and
extends throughout the antepartum period."
The content of such comprehensive care includes
► assessments during preconception,
► at initial presentation for pregnancy care,
► during follow-up prenatal visits.
51. PRECONCEPTIONAL CARE
►A comprehensive preconceptional care
program has the potential to assist women
who want to get pregnant by reducing risks,
promoting healthy lifestyles, and improving
readiness for pregnancy.
52. INITIAL PRENATAL EVALUATION
► Prenatal care should be initiated as soon as there is a
reasonable likelihood of pregnancy. This may be as early
as a few days after a missed menstrual period, especially
for the woman who desires pregnancy termination, but it
should be no later than the second missed period for
anyone. The major goals are:
1. To define the health status of the mother and fetus.
2. To determine the gestational age of the fetus.
3. To initiate a plan for continuing obstetrical care.
53. Recommended Components of the
Initial Prenatal Care Visit
► Risk assessment to include genetic, medical, obstetrical,
and psychosocial factors
► Estimated due date
► General physical examination
► Laboratory tests: hematocrit (hemoglobin), urinalysis, urine
culture, blood grouping, Rh, antibody screen, rubella
status, syphilis screen, Pap smear, HbsAg testing; offer
HIV testing
► Patient education, e.g., use of seatbelts, avoidance of
alcohol and tobacco
► HbsAg = hepatitis B surface antigen; HIV = human
immunodeficiency virus.
54. DEFINITIONS.
• Primipara: a woman who has been delivered only once of a fetus or
fetuses who reached viability. Therefore, completion of any pregnancy
beyond the stage of abortion (Chap. 33, p. 856) bestows parity upon the
mother.
• Multipara: a woman who has completed two or more pregnancies to
viability. It is the number of pregnancies reaching viability, and not the
number of fetuses delivered, that determines parity. Parity is not greater
if a single fetus, twins, or quintuplets were delivered, nor lower if the
fetus or fetuses were stillborn.
• Nulligravida: a woman who is not now, and never has been pregnant.
55. DEFINITIONS.
• Gravida: a woman who is or has been pregnant, irrespective
of the pregnancy outcome. With the establishment of the
first pregnancy, she becomes a primigravida, and with
successive pregnancies a multigravida.
• Nullipara: a woman who has never completed a pregnancy
beyond an abortion. She may or may not have been
pregnant or have had a spontaneous or elective abortion(s).
• Parturient: a woman in labor.
• Puerpera: a woman who has just given birth.
56. NORMAL DURATION OF
PREGNANCY.
►The mean duration of pregnancy calculated
from the first day of the last normal
menstrual period is very close to 280 days,
or 40 weeks.
►It is customary to estimate the expected
date of delivery by adding 7 days to the
date of the first day of the last normal
menstrual period and counting back 3
months (Naegele rule).
58. OBSTETRICAL
EXAMINATION.
Inspection of external genitalia
Speculum examination
Manual or bimanual examination (the
consistency, length, and dilatation of the cervix;
to the fetal presenting part, especially if late in
pregnancy; to the bony architecture of the pelvis;
and to any anomalies of the vagina and
perineum, including cystocele, rectocele, and
relaxed or torn perineum. The vulva and
contiguous structures are also carefully
inspected.
60. HIGH-RISK PREGNANCIES.
► 1. Preexisting medical illness.
► 2. Previous poor pregnancy outcome, such as
perinatal mortality, preterm delivery, fetal-growth
restriction, malformations, placental accidents, or
maternal hemorrhage.
► 3. Evidence of maternal undernutrition.
61. SUBSEQUENT PRENATAL VISITS
RETURN VISITS.
Traditionally the timing of subsequent prenatal
examinations has been scheduled at intervals of 4
weeks until 28 weeks
every 2 weeks until 36 weeks
weekly thereafter
This visits are acceptable in uncomplicated
pregnancies. Conversely, women with complicated
pregnancies often require return visits at 1- to 2-
week intervals.
62. SUBSEQUENT PRENATAL VISITS
FETAL HEART SOUNDS. In essentially all
pregnancies, the fetal heart can first be
heard between 16 and 19 weeks. The ability
to hear unamplified fetal heart sounds will
depend upon several factors, including
patient size and the examiner's hearing
acuity.
63. SUBSEQUENT PRENATAL VISITS
►FUNDAL HEIGHT. Measurement of the
height of the uterine fundus above the
symphysis can provide useful information.
Jimenez and co-workers (1983)
demonstrated that between 20 and 31
weeks the fundal height in centimeters
equaled the gestational age in weeks. The
bladder must be emptied before making the
measurement.
64. PRENATAL SURVEILLANCE. At each return
visit steps are taken to determine the well-
being of both the mother and her fetus.
Fetal
1. Heart rate(s).
2. Size—actual and rate of change.
3. Amount of amnionic fluid.
4. Presenting part and station (late in pregnancy).
5. Activity.
65. PRENATAL SURVEILLANCE.
Maternal
• Blood pressure—actual and extent of change.
• Weight—actual and amount of change.
• Symptoms, including headache, altered vision, abdominal pain, nausea
and vomiting, bleeding, fluid from vagina, and dysuria.
• Height in cm of uterine fundus from symphysis.
• Vaginal examination late in pregnancy often provides valuable
information:
• Confirmation of the presenting part.
• Station of the presenting part
• Clinical estimation of pelvic capacity and its general configuration
• Consistency, effacement, and dilatation of the cervix.
66. LABORATORY TESTS.
► GESTATIONAL DIABETES.
► CHLAMYDIA TRACHOMATIS
► BACTERIAL VAGINOSIS.
► GROUP B STREPTOCOCCUS.
► Determination of maternal serum alpha-
fetoprotein concentration at 16 to 18 weeks (15 to
20 weeks is acceptable) is recommended to screen
for open neural-tube defects and some
chromosomal anomalies.
67. NUTRITION
► • In general, advise the pregnant woman to eat what she wants in amounts
she desires and salted to taste.
► • Make sure that there is ample food to eat, especially in the case of the
socioeconomically deprived woman.
► • Ensure that she is gaining weight, with a goal of about 25 to 35 pounds in
women with a normal body mass index.
► • Periodically, explore the food intake by dietary recall. In this way, the
occasional nutritionally absurd diet will be discovered.
► • Give tablets of simple iron salts that provide at least 30 mg of iron daily. Give
folate supplementation before and in the early weeks of pregnancy.
► • Recheck the hematocrit or hemoglobin concentration at 28 to 32 weeks to
detect any significant decrease.