antenatal care with including all the changes during pregnancy with signs & symptoms of pregnancy. in this presentation i had cover all the topics related to pregnancy unit.

1. Mrs. Sneha Sahay Youtham

2.  Presumptive
 Probable
 Positive

3.  Fatigue
 Tingling sensation in breast
 Quicking
 Uterine enlargement
 Striae gravidarum
 Linea nigra
 Pigmentation on face (Melasma)
 Darken areola
 nausea vomiting
 Amenorrhea
 Color change in vagina
 Frequent urination

4. Probable sign and symptoms
 Enlargement of abdomen
 Pregnancy test positive

5. Positive sign
 Fetal heart sound
 Fetal part palpation
 Visualization of fetus
 Fetal movement

6.  Diet
 Coitus
 Travelling
 Antenatal visit
 Personal care
 Exercise
 Rest and sleep
 Weight gain
 Immunization
 Personal wear
 Medication
 Family support
 Iron and folic acid
 Preparation of confinement


7.  Nausea and vomiting
 Headache
 Fatigue
 Heart burn
 Leg crams
 Fatigue
 sleep disorders
 Constipation
 Varicose vein
 Pails
 Backache
1st
Trimester
2nd
Trimester

8.  Bleeding from vagina
 Excessive vomiting
 Excessive headache
 Vaginal Etching
 Fever
 Frequency of micturition
 Backache
 Bleeding from vagina
 Varicose vein
 Abdominal pain
1st
trimester
2nd
trimester

9.  White discharge
 Premature pain
 Backache
 Continues backhache
3rd
trimester

10. Physiological changes in reproductive organ
 Hypothalmic-pituitary-ovarian axis
 Uterus
 Cervix
 Fallopian tubes
 Ovary
 Vagina vulva
 Breast
Hypothalmic-pituitary-ovarian axis
 Elevated estrogen and progesterone suppresses the FSH
and LH secretion
 Result amenorrhea

11. Uterus
 Obvious gradual change in women body
 Changes occurs in all part of uterus
Comparison of measurement for non pregnant and
pregnant uterus at 48 wks
Measurement Non pregnant Pregnant
Length 7-8 cm 35 cm
Width 4 cm 24 cm
Depth 2 -3 cm 22 cm
Weight 50- 70 gm 1100-1200gm
Volume >10 ml 5000 ml

12. Changes in body parts of uterus
 Growth and enlargement
 Changes in muscle
◦ Hypertrophy and hyperplasia
◦ Stretching
◦ Arrangement of fibrous
 Outer longitudinal
 Inner circular
 Intermediate
 Vascular system: increase blood supply

13. Cervix
 Stroma : hypertrophy and hyperplasia of elastic and
connective tissues, increase vascularity, bluish
discoloration (chadwick sign), softening of cervix
(godells’ sign )
 Secretion : physiological leucorrhea
 Anatomical: the length of cervix is remain unaltered
but become bulky.

14. Vagina and Vulva
 Vagina: increase vascularity cause bluish discoloration of
mucosa (Jacquemeirs’ sign)
 Leucorrhoea: white or slightly gray color due to increase
estrogen and progesterone level
 pH: gets low about 4.0 to become 6.5, makes women
more susceptible to vaginal infection.
 Vulva: becomes edematous and hyperemic, labia minor
becomes more pigmented and hypertrophied
 Perineum: externally enlarged due to increase vascularity
hypertrophied and deposition of fats.

15. Breast
Best evident in primigravida
 Fullness ,tingling ,heaviness as early in 6th
wks of gestation
as result of increase estrogen and progesterone level. Richer
blood supply dilate vessels and becomes visible
(interviewing blue network)
 Increase in size due to proliferation of lactiferous duct and
lobules of alveolar tissues. Functionally complete in mid of
pregnancy. Lactation inhibits until estrogen and
progesterone level gets decreases
 Nipple and Areola: nipple becomes erectile deeply
pigmented and large, secondary areola develops in second
trimester
 Secretion: thin clear viscous secretary material by third of
trimester (precolostrom). Premilk may be expressed from
the nipples by 16th wks

16. Physiological changes in Systemic organs
Pigmentation :
 Face:
 Breast: secondary areola
 Abdomen: linea nigra xiphisterum to symphsis pubis.

17. Weight gain and water metabolism
 The total weight gain during the pregnancy (the course
of singleton) averages 11-12 kg. This has been
distributed in trimester:
 I trimester: 1-2 kg
 II trimester: 4-5 kg
 III trimester: 5-6 kg
 I reproductive : weight gain- 6 kg (Fetus- 3.3 kg,
placenta- 0.6 kg, and liquor- 0.8 kg, uterus-0.9 kg, and
breast- 0.4 kg)
 Net maternal weight gain: 6 kg, Increased blood
volume: 1.3 kg, Increased in extracellular fluid: 1.2 kg,
Accumulation of fats and protein(mainly): 3.5

18. Hematological changes
 Blood volume increased about 16 wks of pregnancy
becomes maximum 40% about than decreases at non-
pregnant level at 30-32 wks
 Blood plasma level concentration increases causes
decline in erythrocytes level
 Blood cells require additional 400mg of iron
 Iron absorption decreases due to decreased gastric
activity during pregnancy
 Leucocytes level gets increases

19.  Total protein increases from the normal 180mg/dl at non
pregnant state
 Blood lipids increases 1/3rd
cholesterol serum level upto
90-100%

20. Heart and circulation
 Earliest changes is peripheral vasodilatation
 heart rate increase (10-20%).
 stroke volume increase (10%).
 cardiac out put increase (30-50%).
 Mean arterial blood pressure decrease (10%)
 Peripheral resistance decrease (35%)
 Diastolic and systolic blood pressure tends to fall
during mid pregnancy and then return to normal by
week 36.

21. Gastrointestinal System
 Appetite is usually increased, sometimes with specific
cravings.
 Progesterone causes relaxation of the lower esophageal
sphincter and increased reflux, making many women prone to
heartburn.
 GI motility is reduced and transit time is consequently longer.
This allows increased nutrient absorption. Constipation is
common.
 Decreases the emptying of bile from gallbladder may result
reabsorption of bilirubin into blood.
 The gallbladder may dilate and empty less completely.
Pregnancy also predisposes to the precipitation of cholesterol
gallstones.
 Gums become spongy, friable and prone to bleeding. Good
dental care is important

22. Urinary system
 Glomerular filtration rate (GFR) increases by 50% early in
pregnancy, increasing creatinine clearance. Serum creatinine
and urea will fall by about 25%.
 Increased GFR also increases filtered sodium. Aldosterone
levels rise by 2-3 times to reabsorb the filtered sodium.
 Increased GFR and impaired tubular reabsorption of glucose
produce glucosuria in approximately 15% of normal
pregnancies.
 Proteinuria is abnormal in pregnancy.
 The smooth muscle of the renal pelvis and ureter become
relaxed and dilated, kidneys increase in length and ureters
become longer, more curved and with an increase in residual
urine volume. Bladder smooth muscle also relaxes, increasing
capacity and risk of UTI. Approximately 5% of pregnant
women have bacteriuria, often asymptomatic, and there is a
greater risk of developing pyelonephritis in pregnancy

23. Respiratory system
 Tidal volume increases by about 200 ml, increasing
vital capacity and decreasing residual volume. In later
stages of pregnancy, splinting of the diaphragm may
occur with some decrease in tidal volume. Respiratory
rate does not alter significantly.
 Increased oxygen consumption by approximately 20%.

24. Musculo-skeletal
 Increased ligamental laxity caused by increased
levels of relaxin contribute to back pain and
pubic symphysis separation and sacroiliac joint
cause walking difficulty.
 Shift in posture with exaggerated lumbar lordosis
leading to the typical gait of late pregnancy

25. Endocrine system
Pituitary
 FSH/LH fall to low levels.
 ACTH and melanocyte-stimulating hormone
increase.
 Prolactin increases.
Adrenal and pancreas
 Cortisol levels increase in pregnancy, which
favours lipogenesis and fat storage.
 Insulin response also increases so blood sugar
should remain normal or low.

26. Thyroid and parathyroid
 Thyroxine-binding globulin (TBG) concentrations rise due to
increased estrogen levels.
 T4 and T3 increase over first half of pregnancy but there is a
normal to slightly decreased amount of free hormone due to
increased TBG-binding.
 TSH production is stimulated, although in healthy individuals
this is not usually significant. A large rise in TSH is likely to
indicate iodine deficiency or subclinical hypothyroidism.
 Serum calcium levels decrease in pregnancy which stimulates
an increase in parathyroid hormone (PTH).
 Colecalciferol (vitamin D3) is converted to its active
metabolite, 1,25-dihydroxycolecalciferol, by placental 1α-
hydroxylase

27. Thank U