This document discusses pregnancy and cryptic pregnancy. It defines pregnancy as beginning with fertilization and outlines the typical stages and duration of a normal pregnancy. It also describes common physiological changes that occur during pregnancy. Cryptic pregnancy is defined as a lack of awareness of pregnancy until late in gestation or delivery. Possible causes of cryptic pregnancy include PCOS, perimenopause, low body fat, and stress. Common symptoms are often mistaken for other conditions. Urine and blood tests may not detect hCG levels in cryptic pregnancies. The document provides recommendations for preventing and treating cryptic pregnancies.

2. PREGNACY
By the end of this presentations learner will be
able to:
 Define PREGNACY
 Discuss how pregnancy happened
 Discuss the Physiological changes of pregnancy
 Duration of the Normal Pregnancy
 Explain the Developmental stages of the Fetus and duration
 Describe the sign and symptoms of Pregnancy
OBJECTIVES

3.  Define CRYPTIC
 Case Study Cryptic pregnancy
 Define Cryptic pregnancy
 Explain the Causes of Cryptic pregnancy
 Discuss Common Symptoms of Cryptic Pregnancy
OBJECTIVES

4.  Epidemiology of Cryptic pregnancy
 Explain the Cryptic Pregnancy Undetected in an Ultrasound
 Why Do Urine and Blood Tests Show Negative Results?
 Periods During Cryptic Pregnancy
 Prevent a Cryptic Pregnancy
 Discuss the Treatment
OBJECTIVES

5. Pregnancy
Pregnancy Cryptic Pregnancy

6. Pregnancy
It is the period from fertilization to birth.

7. Physiology
 It starts when a male’s sperm fertilizes a female’s egg
(ovum) in the woman's fallopian tube, making a
(Zygote) with 46 chromosomes.
 The zygote starts to divide, and after five to seven
days of dividing and growing, it attaches itself to the
wall of the uterus.

8. Continue
 The moment it is implanted in the wall of the uterus
it becomes an (Embryo) and the placenta starts to
develop.
 After 8 weeks, the developing embryo called (Fetus).
 The placenta give the embryo/fetus the oxygen and
nutrition, and removes the waste through the
umbilical cord.

9. Physiological Changes
 Pregnancy causes physiological changes in all
maternal organ systems; most return to normal after
delivery.
 Increased blood supply to breasts and uterus.
 Increased levels of estrogen and progesterone.
 Changes in senses of taste and smell, and increase in
saliva.
 Softening of joints, and increased mobility of the
sacroiliac and symphysis pubis.
 Increased in blood flow.

10. Physiological Changes
 Increased need for glucose, H2O, iron, and folic acid
due to developing fetus.
 Heart rate increases from the normal 70 to as high as
90 beats/min.
 Decrease in blood pressure in first and second
trimesters and became normal at the third trimester.
 Increased breathing rate.
 Increase in kidney and bladder size.
 High pigmentation of the skin.

11. How pregnancy happen?

12. Duration of the Normal Pregnancy
280 days
 or > 9 months
 or > 40 weeks
 or > 3 trimesters
 Normal delivery could be from 38 – 42 weeks.

13. Developmental of Fetus in Uterus
• Developmental of Fetus in Uterus According into three
Trimesters and it’s sign & symptoms…
• 1- First Trimester (1 week -12 week)
- During the first trimester hormonal changes affect
almost every organ system in body.
- The baby develop rapidly. The major organs develop in
this trimester.
- The menstruation stopped.
- Pregnant symptoms and signs (Mood swings,
headache, morning sickness).

14. Conti…………
- The baby’s brain, heart and spinal cord have begun to form.
- Baby's heart starts to beat in the 8th week.
- The sex organs begin to form.
- The face starts to form.
- At the end of eight weeks, the baby is a fetus and looks more like a
human, and about 2.5cm.
- At 12 weeks we can see if he is a boy or girl. And the baby can
make afist.

15. Conti………..
 2- Second trimester (13 week - 28 week)
 Most of the early pregnancy symptoms will gradually
disappear.
 Other symptoms appears such as: backache, leg
swollen, and heartburn.
 Stretch marks on the abdomen and breasts.
 The uterus will grow rapidly in size
 Fetus move at about 18 to 22 weeks.
 Increase of heart rate and blood flow to
accommodate the needs of the fetus.

16. Conti………
 Muscle tissue and bone continue to form.
 Skin begins to form in the 16th week.
 The baby can hear and swallow at the 20th week.
 Real hair begins to grow on your baby's head at 24th
week. The lungs are formed, but do not work.
 At the end of the trimester, the baby now about 30 cm.

17. Conti……..
 3- Third trimester (29 week - 40 week)
 During this final trimester, your fetus grows larger
and the body organs mature. The fetus moves
frequently, especially between the 27th and 32nd
weeks.
 A fetus usually set into a head-down position in the
uterus.
 Shortness of the mother breath.
 Belly button of the mother may stick out.
 The breasts begin to produce colostrum (yellowish
rich milk).

18. Conti……
 The baby’s bones are fully
formed at 34th week.
 The eyes can open and
close and sense changes in
light.
 By the end of 37 weeks,
the baby is considered full
term and the organs are
ready to function on their
own.
 Near the due date, the
baby may turn into a head-
down position for birth.

19. Signs Of Pregnancy
1- Presumptive Signs:
 (physiological changes noticed by the woman herself)
 Absence of menstruation (Amenorrhea)
 Nausea and vomiting (morning sickness): common
from week 2–12.
 Breast tenderness, and swollen.
 Urination frequency.
 Fatigue and sleepiness.

20. Signs of pregnancy
2- Probable Signs:
 (physiological and anatomical changes that can be
perceived by the health care provider)
 Chadwick’s sign: darkness of the vulva.
 Goodell’s sign: Softening of the cervix and vagina
with increased in discharge.
 Hegar’s sign: Softening of the lower uterine
segment.

21. Signs of pregnancy
 Growth of uterus and abdomen.
 Skin hyperpigmentation: brownish pigmentation in
the face, darkness of nipples, linea nigra
(pigmentation of the midline of abdominal skin).
 Positive pregnancy test results: detection of human
chorionic gonadotropin (hCG) in maternal urine or
blood. The tests are accurate, but not 100%.

22. Signs of pregnancy
3- Positive Signs:
 (Objective signs of pregnancy noted by the examiner
by positive examination of the embryo)
 Sonographic visualization of the embryo: Cardiac
movement noted at 4–8 weeks.
 Fetal heart beat: by using a Doppler in the10–12
weeks.
 Fetal movement: felt by the examiner after about 20
weeks.

23. Supplement Given During Pregnancy
 400 micrograms of folic acid every day – from before
you're pregnant until you're 12 weeks pregnant in
order to prevent birth defects known as neural tube
defects, including Spina bifida.
 Iron supplements is given to prevent from anemia .e.g
Iberet-Folic-500mg OD, fefol VIT(iron, vitamins
&folic acid)
 Calcium and vitamin D in pregnancy is important
because Calcium and VIT D is vital for making your
baby's bones and teeth. E.g CaC 1000, tab Osnate D
 2 Tetanus Toxoid dose is given in pregnancy in order
to prevent from tetanus. 1st dose 0.5ml intramuscular
given at 7 month and 2nd dose given at 8 month.

26. CRYPTIC is
from Late Latin
crypticus, from
Greek kryptos,
means “Hidden’’.

27. Case Study Cryptic pregnancy
 24 years old female Patient lived in Canada pregnant
from since 2 year with all sign and symptoms she can
feel them but no any evidence of medical side and
Past medical history
 When she went for checkup , Dr said" it’s a cryptic
pregnancy we can’t see only you can feel them in 9th
month, Dr Adviced for walk daily.

28. Cryptic pregnancy
 Cryptic pregnancy or denial of
pregnancy is defined as lack of
subjective awareness of pregnancy
until final weeks of gestation or
delivery.
 Their relatives, family doctors and
sexual partners are also not aware
of their gravid state.
( Nto Johnson Nto
doi: 10.11604/pamj.2020.36.205.23790)

29. Causes
Polycystic Ovarian
Syndrome (PCOS)
 This condition can limit
your fertility, create
hormonal imbalances,
and cause skipped or
irregular periods.

30. Perimenopause
Time between
when your period
begins to grow less
consistent and
when it stops
completely, which
is marked by
menopause and
decline in estrogen
hormones.

31. Low Body Fat
 For athletes or women with
low body fat, hormonal
levels may fluctuate,
resulting in missed periods.
 This also makes it harder
to detect a pregnancy.

32. Stress
 Nowadays, we face a lot
of stress due to work or
family problems.
 Stress is one of the major
factors of fluctuating
hormone levels, especially
in women.

33. Common Symptoms of Cryptic Pregnancy
 Cryptic pregnancy also shows symptoms,
but women often fail to notice them.
 Period-like bleeding that resembles a regular
menstrual cycle
 Nausea and vomiting that is mistaken for
other conditions
 Fetal movement in the uterus mistaken for
gas or indigestion
 Negative results of urine and blood tests due
to fluctuating hormone levels, especially
when done very early
 No sign of pregnancy in early ultrasounds

34. Epidemiology
 According to the Bushaala, Naji Mustafa (2018-05-
05) In several cases, the pregnancy goes unnoticed
until the would-be mother is twentieth ( 20th) weeks.
 According to the Marco Del Giudice Recent
epidemiological studies show that this condition has a
much higher incidence than previously thought (about
1:475).
 According to the Dordević, Momcilo; Jovanović,
Bozidar; Dordević, Gordana (2010). 1 in 7,225
pregnancies are unknown at the time the mother gives
birth.

35. Cryptic Pregnancy Undetected
in an Ultrasound
 Many times, cryptic
pregnancy goes
undetected even in an
ultrasound. Some
reasons for this are:

36. Retroversion of the Uterus
 Retroversion of the
uterus is a condition where
in the uterus tilts either
sideward or backwards.
 If the uterus is in this
position, it’s hard for an
ultrasound to detect a fetus
during early pregnancy.

37. Bicornuate Uterus
 Bicornuate uterus is a
congenital condition
where in the uterus
grows in a heart shape
with two horn-like
tissues that are divided
partially or fully by a
wall of tissue.
 This makes it harder for
a woman to conceive as
well as increases the
chances of cryptic
pregnancy.

38. Scar Tissue
 Scar tissue doesn’t
allow the ultrasound to
get a clear picture as it
blocks the waves of the
test. Abnormal scarring
may happen due to
stomach surgery or
incomplete abortion in
the past.

39. Why Do Urine and Blood
Tests Show Negative
Results?
In a normal pregnancy, the result
is determined on the basis of the
amount of hCG in the blood.
hCG is a hormone produced by
the placenta during pregnancy.
However, in the case of cryptic
pregnancy, the uterine lining is
regularly removed from the
body, not allowing hCG levels to
build up. Hence, urine and blood
tests cannot detect a pregnancy.

40. Periods During Cryptic Pregnancy
 In cryptic pregnancy, women get
their period every month.
 However, the duration of bleeding
is short.
 It occurs at irregular intervals or is
random.
 The flow also ranges
from spotting to heavy flow and
can be pink, red, black, brown or
even purple.
 This occurs because the uterus is
removing the inner lining and is
not indicative of a miscarriage.

41. Prevent a Cryptic Pregnancy
 If you’re married and sexually active, look out for the
symptoms of a cryptic pregnancy.
 If you experience pain or changes in your abdomen or
pelvic region, then consult a doctor.
 If you don’t get your period regularly, inform your
gynecologist about this condition and get yourself
checked.
 Cryptic pregnancy exercise must.
 Being aware and keeping your gynecologist in the
loop about your reproductive health is the key to
prevent a cryptic pregnancy.

42. Treatment
 Most women do not need to take medication to
relieve perimenopausal effects.
 For some women, symptoms are especially
bothersome and hormone replacement therapy (HRT)
can be helpful.
 In other instances, symptomatic treatment aimed at
controlling specific effects, such as depression,
anxiety, or hair loss, are the best fit.

43. References
 Nto-Ezimah UA, Nto NJ, Esom EA, Okwor CJ, Adiri
C. Unexpected delivery: a case report of cryptic
pregnancy in Nigeria. The Pan African Medical
Journal. 2020;36.
 The North American Menopause Society. The Experts
Do Agree About Hormone Therapy.
 Kaunitz AM, Manson JE. Management of
Menopausal Symptoms. Obstet Gynecol.
2015;126(4):859–876.
doi:10.1097/AOG.0000000000001058

44. References
 Dordević, Momcilo; Jovanović, Bozidar; Dordević,
Gordana (2010). "Unknown pregnancy--presentation
of the case". Medicinski pregled. 63 (9–10): 728–
730. doi:10.2298/mpns1010728d