The document provides an overview of physiological changes during pregnancy presented by Alemyehu T. It describes changes in various body systems including increased blood volume, cardiac output and relaxed smooth muscles. Key stages of development are defined, from fertilization to implantation of the embryo. Major organ changes are also summarized such as uterine enlargement and breast development in preparation for lactation.
Rh Incompatibility I Hemolytic Disease of the NewbornSwatilekha Das
Rh Incompatibility I Hemolytic Disease of the Newborn-
Hi All,
I am Swatilekha Das, B.Sc, M.Sc Nurse and working as Assistant Professor of Nursing in a Nursing college. I worked as Clinical Instructor, nursing educator, nursing trainer, Nursing Tutor at hospitals, nursing schools and colleges.
ABOUT THIS ppt-
In this ppt I discussed about definition of rh incompatibility, cause, pathophysiology, diagnostic tests, treatment and screening and prevention of Rh incompatibility.
To know about it check the ppt till end.
I hope you enjoy this ppt and if you do then please click on the like button and share the with your friends too . Don't Forget to follow to see more such ppt. Thank you for checking the ppt.
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It is a chapter in obstetrics. it is important to know what happens after pregnancy. it includes definition, involution of the uterus,lochia, general physiological changes , lactation, physiology of lactation etc. it is very knowledgeable ppt. please read this vey carefully.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Rh Incompatibility I Hemolytic Disease of the NewbornSwatilekha Das
Rh Incompatibility I Hemolytic Disease of the Newborn-
Hi All,
I am Swatilekha Das, B.Sc, M.Sc Nurse and working as Assistant Professor of Nursing in a Nursing college. I worked as Clinical Instructor, nursing educator, nursing trainer, Nursing Tutor at hospitals, nursing schools and colleges.
ABOUT THIS ppt-
In this ppt I discussed about definition of rh incompatibility, cause, pathophysiology, diagnostic tests, treatment and screening and prevention of Rh incompatibility.
To know about it check the ppt till end.
I hope you enjoy this ppt and if you do then please click on the like button and share the with your friends too . Don't Forget to follow to see more such ppt. Thank you for checking the ppt.
@All Rights Reserved..
It is a chapter in obstetrics. it is important to know what happens after pregnancy. it includes definition, involution of the uterus,lochia, general physiological changes , lactation, physiology of lactation etc. it is very knowledgeable ppt. please read this vey carefully.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
This topic includes difference between female and male pelvis, various pelvis types, general description of pelvis bones, division of pelvis, landmarks of pelvis, plane, axis, sacral angle, diameters of inlet, cavity and outlet.
Physiological changes in second stage of laborDR MUKESH SAH
There is an interplay of physiological processes occurring during the second stage of labour. Second stage is said to have two phases, latent and active. It is during the latent phase that the presenting part passes through the fully dilated cervix to the birth canal.
DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Wondering if you could be pregnant? Do you even know the presumptive, probable and positive signs of pregnancy? After a couple of weeks since you did lovemaking and now can’t wait for the confirmation, you’re confuse and still holding with the feeling of being pregnant. Can you distinguish those signs and symptoms? Are you familiar with their differences? Let’s find out each distinction.
This topic includes difference between female and male pelvis, various pelvis types, general description of pelvis bones, division of pelvis, landmarks of pelvis, plane, axis, sacral angle, diameters of inlet, cavity and outlet.
Physiological changes in second stage of laborDR MUKESH SAH
There is an interplay of physiological processes occurring during the second stage of labour. Second stage is said to have two phases, latent and active. It is during the latent phase that the presenting part passes through the fully dilated cervix to the birth canal.
DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
Wondering if you could be pregnant? Do you even know the presumptive, probable and positive signs of pregnancy? After a couple of weeks since you did lovemaking and now can’t wait for the confirmation, you’re confuse and still holding with the feeling of being pregnant. Can you distinguish those signs and symptoms? Are you familiar with their differences? Let’s find out each distinction.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
The placenta is a large organ that develops during pregnancy.Blood from the mother passes through the placenta, filtering oxygen, glucose and other nutrients to your baby via the umbilical cord.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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2. OBJECTIVES OF THE LECTURE
At the end of this chapter the students will be
able to:
Describe physiological changes during pregnancy
list pregnancy diagnosis methods
Describe stage of embryological development
Enumerate the functions of placenta
Identify major care given for pregnant women
during pregnancy
By Alemyehu T March 22-2014 2
3. Define the following terminologies
Ovulation
Fetus
Fertilization
newborn
Zygote
Neonate
Implantation
Toddler
Embryo
Child
Pregnancy
adolescent
By Alemyehu T March 22-2014 3
4. It is the maternal condition of having a developing embryo or
fetus in the uterus.
Pregnancy literally means (being with the child).
The Normal pregnancy average duration is counting from first
day of last menstrual period is about 280 days or 40 weeks.
It starts at fertilization.
It ends at delivery of the fetus and placenta.
By Alemyehu T March 22-2014 4
5. Ovulation is the process in a female’s menstrual cycle by
which a mature ovarian follicle raptures and discharges an ovum.
The process requires a maximum of 36hours to complete, and
it is arbitrarily separates in to three phases
oPreovulatory(proliferative phase)
oOvulatory and
oPost ovulatory
By Alemyehu T March 22-2014 5
6. Fer tilization:
Fusion of the ovum(23x) and matured spermatozoa(23x or
23y)
It takes place in the fallopian tubes.
Fertilization must occur fairly quickly after release of the ovum
because it usually occurs in the outer third of a fallopian tube,
the ampullar portion.
The functional life span of spermatozoa is about 48 hours /
may be as long as 72 hours or longer
Therefore, sexual coitus during this time may result in
fertilization /pregnancy.
By Alemyehu T March 22-2014 6
7. By Alemyehu T March 22-2014
Fertilization
in the
ampulle of
the FT.
7
8. Zygote:
(46xx or 46xy) is a cell that results from fertilization.
After fertilization the ova passes through the fallopian tube
and reaches the uterus 3 or 4 days later.
It divides and redivides forming daughter cells named
blastomeres.
Division takes place and the fertilized ovum divides into two
cells, and then into four, then eight, and sixteen and soon until
a cluster of cells is formed known as the morula.
It reaches 16 cell stage, it is named morula.
By Alemyehu T March 22-2014 8
9. These divisions occur quite slowly about once every 12 hours
When fluid filled cavity appears in the morula a blastocyst is
formed.
The cells of blastocyst are arranged in to two layers
Outer layer called trophoblast
Develops in to the placenta & chorion
Inner layer is called embr yoblast
Rise to the fetus, umbilical cord & amnion
By Alemyehu T March 22-2014 9
10. By Alemyehu T March 22-2014
Blastocyst
Trophoblast Inner cell mass
Placenta
Chorion
Fetus
Amnion
Umbilical
cord
A
10
11. The inner cell mass differentiate into three layers, each of which will
form particular parts of the fetus.
The ectoderm mainly forms the skin and nervous system
The mesoderm forms bones and muscles and also the heart and
blood vessels, including those which are in placenta.
The endoderm forms mucous membranes and glands.
The three layers together are known as the embryonic plate.
By Alemyehu T March 22-2014 11
12. Embryo is the stage after the inner layer formed two layer
(bilaminar disc).
Embryonic period is a period where major structures are
formed and extends up to the end of seven weeks after
fertilization.
Fetus is developing conceptus after the embryonic period.
Conceptus is all tissue products of conception (embryo/fetus,
fetal membranes, and placenta)
By Alemyehu T March 22-2014 12
13. On day 4 after fertilization the blastocyst enters into the
uterine cavity.
By day 7, it starts embedding itself in to the prepared
endometrium which is know called the decidua and this
process is called implantation.
Implantation is an event that occurs early in pregnancy in
which the embryo adheres to the wall of the uterus.
By Alemyehu T March 22-2014 13
14. There are many physiologic changes in pregnancy.
Some mimic the signs, symptoms, or laboratory finding of
disease in the nonpregnant woman yet are normal in
pregnancy.
Therefore , knowledge of normal maternal physiologic
changes helps avoid unnecessary diagnostic or therapeutic
interventions.
By Alemyehu T March 22-2014 14
15. There are physiological, biochemical and anatomical changes that
occur during pregnancy.
These changes may be systemic or local.
Most of the systemic changes return to pre pregnancy status 6
weeks after delivery.
These changes occur during pregnancy to maintain a healthy
environment for the fetus with out compromising the mother’s
health.
By Alemyehu T March 22-2014 15
16. 1-Systemic changes:
-volume homeostasis.
-blood
-cardio vascular system.
2-Respiratory changes.
3-urinary tract and renal function.
4-Alimentary tract.
5-Reproductive organs.
6-endocrinological changes.
By Alemyehu T March 22-2014 16
17. A. volume homeostasis:
Fluid retention is the most fundamental systemic changes of
normal pregnancy.
The total blood volume is increased during pregnancy 30%.
The most marked expansion occurs in extra cellular volume
(ECV) with some increase in intra cellular water.
By Alemyehu T March 22-2014 17
18. The contributing factors includes:
Increase sodium retention.
Decrease in plasma osmotic pressure.
Decrease in thirst threshold.
Resetting of osmostate.
Decrease in plasma oncotic pressure.
By Alemyehu T March 22-2014 18
19. Blood Volume
Blood volume expansion begins early in the first trimester, increases rapidly
in the second trimester, and plateaus at about the 30th week (Fig 7–1). The
approximately 50% elevation in plasma volume, which accounts for most of
the increment, results from a cascade of effects triggered by pregnancy
hormones. For example, increased estrogen production by the placenta
stimulates the renin-angiotensin system, which, in turn, leads to higher
circulating levels of aldosterone. Aldosterone promotes renal Na+
reabsorption and water retention. Progesterone also participates in plasma
volume expansion through a poorly understood mechanism; increased
venous capacitance is another important factor. Human chorionic
somatomammotropin, progesterone, and perhaps other hormones promote
erythropoiesis, resulting in the about a 30% increase in red cell mass.
By Alemyehu T March 22-2014 19
20. Increase in blood volume – most striking change
The change occurs until term and the average increase in volume
is 45-50%
The mechanism for increase the volume of blood is not well
understood (aldosterone related factor during pregnancy may
contribute to this effect), increase water and salt retention.
By Alemyehu T March 22-2014 20
21. RBC increased by 33%
Iron need increases because of increase in red
blood cell mass.
This is why Iron suplimentation is necessary
during pregnancy.
WBC total count usually increase
Platelets increase in production
By Alemyehu T March 22-2014 21
22. Hear t slightly shift in position( left-upward
displacement)
Enlarging Uterus diaphragm → → displace up ward
Results in decreased systemic vascular resistance→
↑CO 6 L/ min. Max. (22-28)wks.
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%).
By Alemyehu T March 22-2014 22
23. Blood Pressure
Systemic blood pressure declines slightly during pregnancy.
There is little change in SBP but
DBP decrease by 5-10 mmHg from 12-26 weeks,
then increase to non pregnant level by term.
By Alemyehu T March 22-2014 23
24. Capillary dilatation occurs in the respiratory route
(Nasopharynx, larynx, trachea, bronchi) →make breathing
difficult through nose,
enlarged Uterus pushes the diaphragm and the lungs as well.
By Alemyehu T March 22-2014 24
25. Blood flow increase (60-70%).
Glomerular filtration increased (50%).
clearance of most substances is enhanced.
Plasma creatinine and urea are reduced
Glycosuria is normal.
Bladder
Is displaced upward and anteriorly by enlarged uterus as a result it
increases pressure leading to and urinary urgency and frequency.
By Alemyehu T March 22-2014 25
26. The gums becomes spongy.
The lower oesophageal sphincter is relaxed (hurt burn).
Gastric secretion is reduced.
The intestinal musculature is relaxed (constipation).
By Alemyehu T March 22-2014 26
27. A. the uterus:
Upper part fundus and body change in to upper uterine
segment.
Lower part cervix and isthmus change in to lower uterine
segment
Weight increases from 60gm to l kg at term, volume 10ml to
5 liters.
By Alemyehu T March 22-2014 27
28. B. the cer vix:
The cervix becomes softer and swollen in pregnancy with the
result columnar epithelium lining cervical canal becomes
exposed to vaginal secretion.
The mucus gland becomes distended and secrete mucus
which forms a mucus plug that is expelled in labour as the
show.
Prostaglandins and collagenase especially in last weeks of
pregnancy act on collagen fiber make cervix more softer.
By Alemyehu T March 22-2014 28
29. C. the vagina :
The vaginal mucosa becomes thicker during pregnancy.
The vaginal discharge during pregnancy increased due to
increase desquamation of the superficial vaginal mucosal cells.
By Alemyehu T March 22-2014 29
30. D-breasts and lactation :
Breast increases in size with enlargement of the nipple
and increased vascularity and pigmentation of areola.
The earliest changes is a swelling of the breast tissue.
Estrogen leads to increase in number of glandular ducts.
Progesterone leads to proliferation of glandular epithelium of
the alveoli.
Prolactin leads to active secretion of milk after birth.
By Alemyehu T March 22-2014 30
31. Prolactin concentration increases markedly but act after
delivery.
Human growth hormone is suppressed .
Insulin resistance develop.
Thyroid function changes little.
Trans placental calcium transport is enhanced.
Corticosteroid concentration increased.
Aldosterone concentration increased.
Angiotensin and renine increased
By Alemyehu T March 22-2014 31
32. human chorionic gonadotropin (HCG):
It is secreted by trophoblast and can be detected in serum 10
days after conception (RIA).
There is high level of circulating HCG in early pregnancy (to
provide a suitable environment for implantation and
development).
To support corpus luteum secretion of estrogen and
progesterone in the first trimester until the placenta becomes
able to produce these hormone.
By Alemyehu T March 22-2014 32
33. The peak level normally occur in the 12th week
Constant level of HCG in late pregnancy is
useful in:
Controlling placental secretion of Estrogen progesterone.
Suppressing maternal immune system against fetus.
The human chorionic gonadotropin normally disappear from
urine 7-10 days after delivery of placenta.
By Alemyehu T March 22-2014 33
34. It is secreted by syncytotrophoblast.
Its level increase when the level of HCG start to drop .
HPL has no effect on fetus.
• HPL effect on :
1-the breast:
o Mammary growth during pregnancy.
o Produce of colostrums.
o Milk production lactation.
By Alemyehu T March 22-2014 34
35. 2-Protiens:
HPL stimulate protein synthesis at cellular level.
3-Carbohydrate:
Stimulate insulin secretion .
Inhibit insulin action.
4-Fat:
HPL mobilize fat from body store (lypolysis) lead to increase
maternal blood glucose and maternal tissue can not utilize the
glucose so the glucose will be available for fetus.
By Alemyehu T March 22-2014 35
36. It is produced by corpus luteum in early pregnancy and
placenta in late pregnancy.
Role of estrogen:
On connective tissue: estrogen leads to polymerization of
monosaccharaides of the ground substance leads to loose
connective tissue mainly in the cervix.
On the protein: estrogen stimulate directly RNA synthesis
lead to protein synthesis.
By Alemyehu T March 22-2014 36
37. Its production is the same as estrogen.
It has effect on smooth muscle leads to decrease muscle
excitability leads to muscle relaxation mainly in uterus.
By Alemyehu T March 22-2014 37
38. 1) -------is the maternal condition of having a developing embryo
or fetus in the uterus.
2) The normal pregnancy average duration is counting------------
days.
3) Pregnancy starts from------ and ends at ----------.
4) ------is the process in a female’s menstrual cycle by which a
mature ovarian follicle raptures and discharges an ovum.
5) How many days required to complete ovulation?
By Alemyehu T March 22-2014 38
39. 1. What is the out come of fertilization?
2. ------is the name of daughter cells, results from zygote division.
3. What is morula?
4. When fluid filled cavity appears in the morula ------- is
formed.
5. Trophoblast develops in to -------& -------.
6. Which inner cell layer is forms bones, muscles, heart and blood
vessels?
By Alemyehu T March 22-2014 39
40. Pregnancy is mainly diagnosed on the symptoms reported
by the woman and signs elicited by a health care provider.
Signs and symptoms of pregnancy
These signs and symptoms are divided in to three(3Ps)
classifications;
presumptive,
probable, and
positive
By Alemyehu T March 22-2014 40
41. PRESUMPTIVE SIGNS AND SYMPTOMS OF
PREGNANCY;
Presumptive signs and symptoms of pregnancy are those signs
and symptoms that are usually noted by the patient, which impel
her to make an appointment with a physician.
These signs and symptoms are not proof of pregnancy but they
will make the physician and woman suspicious of pregnancy.
By Alemyehu T March 22-2014 41
42. 1. Amenor rhea (Cessation of Menstruation)
Amenorrhea is one of the earliest clues of pregnancy.
The majority of patients have no periodic bleeding after the
onset of pregnancy.
However, at least 20 percent of women have some slight,
painless spotting during early gestation for no apparent reason
and a large majority of these continue to term and have normal
infants.
By Alemyehu T March 22-2014 42
43. Other causes for amenorrhea must be ruled out, such as:
Menopause.
Stress (severe emotional shock, tension, fear, or a strong desire
for a pregnancy).
Chronic illness (tuberculosis, endocrine disorders, or central
nervous system abnormality).
Anemia.
Excessive exercise.
By Alemyehu T March 22-2014 43
44. 2. Nausea and Vomiting (Mor ning
Sickness)
Usually occurs in early morning during the first weeks of
pregnancy.
Usually spontaneous and subsides in 6 to 8 weeks or by the
twelfth to sixteenth week of pregnancy.
Hyperemesis gravidarum. This is referred to as nausea and
vomiting that is severe and lasts beyond the fourth month of
pregnancy. It causes weight loss and upsets fluid and electrolyte
balance of the patient.
By Alemyehu T March 22-2014 44
45. Nausea and vomiting are unreliable signs of pregnancy since they
may result from other conditions such as:
Gastrointestinal disorders (hiatal hernias, ulcers, and
appendicitis).
Infection (influenza and encephalitis).
Emotional stress, upset (anxiety and anorexia nervosa).
Indigestion.
By Alemyehu T March 22-2014 45
46. 3. Frequent Urination
Frequent urination is caused by pressure of the expanding uterus
on the bladder.
It subsides as pregnancy progresses and the uterus rises out of the
pelvic cavity.
The uterus returns during the last weeks of pregnancy as the head
of the fetus presses against the bladder.
Frequent urination is not a definite sign since other factors can be
apparent (such as tension, diabetes, urinary tract infection, or
tumors).
By Alemyehu T March 22-2014 46
47. 4. Breast Changes
In early pregnancy, changes start with a slight, temporary
enlargement of the breasts, causing a sensation of weight, fullness,
and mild tingling.
By Alemyehu T March 22-2014 47
48. As pregnancy continues the patient may notice:
Darkening of the areola--the brown part around the nipple.
Increased firmness or tenderness of the breasts.
More prominent and visible veins due to the increased blood
supply.
Presence of colostrum (thin yellowish fluid that is the precursor
of breast milk).
NB ; These breast changes can be more positive if the patient
has not recently delivered and is not presently breastfeeding.
By Alemyehu T March 22-2014 48
49. 5. Quickening (Feeling of fetal mov’t)
This is the first perception of fetal movement within the uterus.
A multigravida can feel quickening as early as 16 weeks.
A primigaravida usually cannot feel quickening until after 18
weeks.
By Alemyehu T March 22-2014 49
50. 6. Skin Changes.
Striae gravidarum (stretch marks):
These are marks noted on the abdomen and/or buttocks.
These marks are caused by increased production or sensitivity to
adrenocortical hormones during pregnancy, not just weight gain.
By Alemyehu T March 22-2014 50
51. Linea nig ra;
This is a black line in the midline of the abdomen that may run
from the sternum or umbilicus to the symphysis pubis.
This appears on the primigravida by the third month and keeps
pace with the rising height of the fundus.
The entire line may appear on the multigravida before the third
month.
This may be a probable sign if the patient has never been
pregnant.
By Alemyehu T March 22-2014 51
53. Chloasma:
This is called the "Mask of Pregnancy.“
It is a bronze type of facial coloration seen more on dark-haired
women.
It is seen after the sixteenth week of pregnancy.
Fingernails:
Some patients note marked thinning and softening by the sixth
week.
By Alemyehu T March 22-2014 53
54. 7. Fatigue or weakness:
This is a common complaint by most patients during the first
trimester.
Fatigue may also be a result of anemia, infection, emotional
stress, or malignant disease.
By Alemyehu T March 22-2014 54
55. Probable signs of pregnancy are those signs commonly noted by the
physician upon examination of the patient or the client.
These signs include:
1. Uterine Changes
Position:- By the twelfth week, the uterus rises above the symphysis pubis
and it should reach the xiphoid process by the 36th week of pregnancy.
These guidelines are fairly accurate only as long as pregnancy is normal
and there are no twins, tumors, or excessive amniotic fluid.
By Alemyehu T March 22-2014 55
57. Size:- The uterine increases in width and length approximately
five times its normal size. Its weight increases from 60 grams to
1,000 grams.
2.Abdominal Changes
This corresponds to changes that occur in the uterus, as the
uterus grows, the abdomen gets larger.
Abdominal enlargement alone is not a sign of pregnancy.
Enlargement may be due to uterine or ovarian tumors, or edema.
By Alemyehu T March 22-2014 57
58. 3. Cer vical Changes.
Formation of a mucous plug.
This is due to hyperplasia of the cervical glands as a result of
increased hormones.
It serves to seal the cervix of the pregnant uterus and to protect
it from contamination by bacteria in the vagina.
By Alemyehu T March 22-2014 58
59. 4. Basal Body Temperature
This is a good indication if the patient has been recording for
several cycles previously.
A persistent temperature elevation spanning over 3 weeks since
ovulation is noted.
Basal body temperature (BBT) is 97 percent accurate.
By Alemyehu T March 22-2014 59
60. 5. Fetal Palpation
This is a probable sign in early pregnancy.
The physician can palpate the abdomen and identify fetal parts.
It is not always accurate.
By Alemyehu T March 22-2014 60
61. Positive signs of pregnancy are those signs that are definitely
confirmed as a pregnancy.
They include :
fetal hear t sounds,
ultrasound scanning of the fetus,
palpation of the entire fetus,
palpation of fetal movements,
x-ray, and
actual deliver y of an infant.
By Alemyehu T March 22-2014 61
62. 1. Fetal Hear t Sounds
The fetal heart begins beating by the 24th day following
conception.
It is audible with a Doppler by 10 weeks of pregnancy and with
a fetoscope after the 16th week.
The normal fetal heart rate is 120 to 160 beats.
By Alemyehu T March 22-2014 62
65. 2. Ultrasound Scanning of the Fetus
The gestation sac can be seen and photographed.
An embryo as early as the 4th week after conception can be
identified.
The fetal parts begin to appear by the 10th week of gestation.
By Alemyehu T March 22-2014 65
67. 3. Palpation of the Entire Fetus
Palpation must include the fetus head, back, and upper and
lower body parts.
This is a positive sign after the 24th week of pregnancy if the
woman is not obese.
4. Palpation of Fetal Movement
This is done by a trained examiner.
It is easily elicited after 24 weeks of pregnancy.
By Alemyehu T March 22-2014 67
72. 5. X-ray
An x-ray will identify the entire fetal skeleton by the 12th week.
In utero, the fetus receives total body radiation that may lead to
genetic or gonadal alterations.
An x-ray is not a recommended test for identifying pregnancy.
6. Actual delivery of an infant
Self-explanatory.
By Alemyehu T March 22-2014 72
73. A. Tests are based on the presence of human chorionic
gonadotropin (HCG) in the urine or blood.
1)Urine. This test can be performed accurately 42 days after the
last menstrual period or 2 weeks after the first missed period.
The first urine specimen of the morning is the best one to use.
2)Blood. Radioimmunoassay (RIA) can detect HCG in the
blood 2 days after implantation or 5 days before the first
menstrual period is missed.
By Alemyehu T March 22-2014 73
74. Human chorionic gonadotropin (hCG) is a glycopeptide
hormone produced by the placenta during pregnancy.
The appearance and rapid rise in the concentration of hCG in
the woman's urine makes it a good pregnancy marker.
Usually, concentration of hCG in urine is at least 25 mIU/ml
as early as seven to ten days after conception.
The concentration increases steadily and reaches its maximum
between the eighth and eleventh weeks of pregnancy.
By Alemyehu T March 22-2014 74
75. Bring test components and specimens to room temperature
prior to testing.
Remove a Testing Device from the foil pouch by tearing at the
"notch" and place it on a level surface.
Holding a Sample Dropper vertically, add exactly four drops of
the urine specimen to the sample well.
Read results at time indicated in procedure.
By Alemyehu T March 22-2014 75
78. If two color bands are visible the test is positive.
The presence of a Control Band only indicates a negative test.
By Alemyehu T March 22-2014 78
79. The Control Band is used as a reference and built in quality
control check.
If the Test Band is darker or similar to the Control band, the test
result is considered positive.
The Control Band is used for procedural control to check
whether the test reagents are working properly and that a
sufficient amount of urine sample has been applied to the test
area.
By Alemyehu T March 22-2014 79
80. If, after performing the test, no purple color band is visible
anywhere within the Results Window, the result is considered
invalid.
If a color appears in the test area but NO color appears in
the control area, the test is invalid.
By Alemyehu T March 22-2014 80
83. The directions may not have been followed correctly.
Inadequate amount of sample has been exposed to the test
system.
The test may have deteriorated.
By Alemyehu T March 22-2014 83
84. Do not use test kit components after the expiration dates.
Dispose of all used test components in a proper biohazard
container.
If specimens or test components have been stored in a
refrigerator, allow them to warm to room temperature before
performing the test.
Human specimens should be handled as if capable of
transmitting infectious agents.
March 22-2014
By Alemyehu T
84
85. Besides pregnancy, elevated concentrations of hCG may be
found in patients with both gestational and non-gestational
trophoblastic diseases.
These conditions should be ruled out in the interpretation of
hCG levels to establish a diagnosis of pregnancy.
A low incidence of false results can occur.
Consult with a physician if unexpected or inconsistent results.
A normal pregnancy cannot be distinguished from an ectopic
pregnancy based on hCG levels alone.
A spontaneous miscarriage may cause confusion in interpreting
the test results. By Alemyehu T March 22-2014 85
87. Fer tilization
•1 day post-ovulation
SPERM + EGG(OOCYTE) = ZYGOTE
The fertilization process takes about 24 hours.
Sperm life = 48 hours/72hours
It takes about ten hours to navigate the female
Reproductive track, moving up the vaginal canal, through the
cervix, and into the fallopian tube where fertilization begins.
By Alemyehu T March 22-2014 87
89. Cleavage(division)
•1 - 3 days post-ovulation
The zygote now begins to cleave, with each division occurring
into two cells called blastomeres.
The zygote's first cell division begins a series of divisions, with
each division occurring approximately every twelve hours.
By Alemyehu T March 22-2014 89
90. When cell division generated about sixteen cells, the zygote
becomes a morula (mulberry shaped)
It leaves the fallopian tube and enters the uterine cavity three to
four days after fertilization.
By Alemyehu T March 22-2014 90
93. Blastocyst
•3 - 5 days post-ovulation
Two cell types are forming:
Embryoblast (inner cell mass on the inside of the blastocele)
Trophoblast (the cells on the outside of the blastocele).
By Alemyehu T March 22-2014 93
94. Implantation
5 - 7 days post-ovulation
The trophoblast cells secretes an enzyme which erodes the
epithelial uterine lining and creates an implantation site for the
blastocyst.
Ovary continues producing progesterone
By Alemyehu T March 22-2014 94
95. Trophoblast cells continue releasing human chorionic
gonadotropin (hCG)
Endometrial glands in the uterus enlarge in response to the
blastocyst and the implantation site becomes swollen with new
capillaries.
Circulation begins, a process needed for the continuation of
pregnancy.
By Alemyehu T March 22-2014 95
97. Gastrulation, Chorionic Villi Formation
•13 days post-ovulation
The formation of blood and
blood vessels of the embryo begins
Yolk sac begins to produce hematopoietic or
non-nucleated blood cells.
Gastrulation three layers of the embryo:
ectoderm, mesoderm and endoderm.
By Alemyehu T March 22-2014 97
99. Neurulation and Notochordal Process
16 days post-ovulation
Endoderm forms the lining of lungs, tongue, tonsils, urethra
and associated glands, bladder and digestive tract.
Mesoderm forms the muscles, bones, lymphatic tissue, spleen,
blood cells, heart, lungs, and reproductive and excretory systems.
Ectoderm forms the skin, nails, hair, lens of eye, lining of the
internal and external ear, nose, sinuses, mouth, anus, tooth enamel,
pituitary gland, mammary glands, and all parts of the nervous
system.
By Alemyehu T March 22-2014 99
100. Primitive Pit (depression, cavity), Notochordal Canal
and Neurenteric Canals
• 17-19 days post-ovulation
The blood cells of the embryo are already developed and they begin to
form channels along the epithelial cells which form consecutively with
the blood cells.
• STAGE 8:19 - 21 days post-ovulation
Endocardial (muscle) cells begin to fuse and form into the early
embryo's two heart tubes.
By Alemyehu T March 22-2014 100
101. 21 - 23 days post-ovulation
• Cardiac muscle contraction begins
• Eye & ear cells are present
• Neural tube starts closing
By Alemyehu T March 22-2014 101
102. 23 - 25 days post-ovulation
A primitive S-shaped tubal heart is beating and peristalsis,
the rhythmic flow propelling fluids throughout the body,
begins.
At this stage, the neural tube determines the form of the
embryo
By Alemyehu T March 22-2014 102
103. 25 - 27 days post-ovulation
The brain and spinal cord together are the largest and most
compact tissue of the embryo.
Valve & septa appear in the heart
The digestive epithelium layer begins to differentiate into the
future locations of the liver, lung, stomach and pancreas.
The beginning cells of the liver form before the rest of the
digestive system.
By Alemyehu T March 22-2014 103
104. Approximately 27-29 postovulatory days
Forebrain, midbrain and hindbrain.
Forebrain senses, memory formation, thinking, reasoning,
problem solving.
Midbrain relay station, coordinating messages to their final
destination
Hindbrain regulates the heart, breathing and muscle
movements
By Alemyehu T March 22-2014 104
105. Lymphatic & thyroid start to develop
Limb buds
First thin layer of skin
Liver & heart, etc.
By Alemyehu T March 22-2014 105
106. 4 to 8 weeks post fer tilization
Nervous sys developing further
4 chamber heart
lung sacs
Ureteric bud appear
Nerve distribution process, innervation, begins in the upper
limbs.
By Alemyehu T March 22-2014 106
107. 6 to 8 weeks post fertilization
Further development of nervous system, heart.
Innervations, the distribution of nerves, begins in the lower limb
buds.
By Alemyehu T March 22-2014 107
108. Approximately 41 postovulatory days
A Four Chambered Heart and a Sense of Smell
Primitive germ cells arrive at the genital area and will respond
to genetic instructions to develop into either female or male
genitals.
By Alemyehu T March 22-2014 108
109. Approximately 47-48 post ovulation days
Brain Waves and Muscles
The trunk elongates and straightens
The bone cartilage begins to form a more solid structure.
Muscles develop and get stronger.
By Alemyehu T March 22-2014 109
110. 48-52 days post ovulation
Spontaneous Involuntary Movement
Brain is connected to tiny muscles and nerves and enables the
embryo to make spontaneous movements
Testes or ovaries are distinguishable
By Alemyehu T March 22-2014 110
111. approximately 56 - 57 post ovulation days
essential external and internal structures complete
layer of rather flattened cells, the precursor of the surface layer
of the skin, replaces the thin ectoderm of the embryo.
By Alemyehu T March 22-2014 111
112. Week 10 - 11
Vocal cords formed
Liver secretes bile, stored in the GB
Pancreas produces insulin
Reflexes present
Male/female differentiate
By Alemyehu T March 22-2014 112
113. Week 12 - 13
Fetus begins to move
Heartbeat can be found with Doppler
Fetal sex now clearly distinguished
Body begins to grow hair (lanugo)
By Alemyehu T March 22-2014 113
115. Week 16 Post Fertilization
Growth continues, but no new structures form after this point
Meconium begins to accumulate in the bowels.
Meconium is the product of cell loss, digestive secretion and
swallowed amniotic fluid.
Placenta equal in size to fetus
By Alemyehu T March 22-2014 115
117. Week 18 Post Fer tilization
A dramatic growth period for the fetus.
Fetus has phases of sleep and walking and may prefer a favorite
sleep position.
Ovaries containing primitive egg cells & uterus present
Placenta is fully formed and grows in diameter though not in
thickness.
By Alemyehu T March 22-2014 117
118. Week 20
Fetus sucks thumb
Extremely rapid brain growth (which lasts until five years after
birth) begins.
Testes of male fetuses begin descending from the pelvis into
the scrotum.
Arms and legs move with more force, as muscles strengthen.
By Alemyehu T March 22-2014 118
119. Week 26
Lungs may be mature enough to breath air!
Fetal body is two to three percent body fat.
Eyes are partially open and eyelashes present.
Sucking and swallowing improves.
By Alemyehu T March 22-2014 119
120. Week 30
Body growth slows down
The iris is colored
The pupil reflexes responding to light.
By Alemyehu T March 22-2014 120
121. Week 32
Fetus rests on uterus - no longer floating.
Eyes open during alert times and close during sleep.
Eye color is usually blue, regardless of the permanent color as
pigmentation is not fully developed
By Alemyehu T March 22-2014 121
122. Week 34
Head may now position (head-down) into pelvis before labor.
Gastrointestinal system is very immature and will stay that way
until three or fourth years after birth.
Fetus stores about 15% of weight in fat to keep temperature of
body warm
By Alemyehu T March 22-2014 122
123. 40 weeks
Full term
15% of body is fat,
80% of which is underneath the skin,
the other 20% around the organs.
By Alemyehu T March 22-2014 123
124. It is temporary organ joining the mother and fetus.
It receives nutrients, oxygen, antibodies and hormones from the
mother’s blood and passes out waste.
By Alemyehu T March 22-2014 124
125. Respiration –
As pulmonary exchange of gases does not take place in the
uterus the fetus must obtain oxygen and excrete carbon dioxide
through the placenta.
Nutrition –
Food for the fetus derives from the mother’s diet and has already
been broken down into forms by the time reaches the placenta
site.
By Alemyehu T March 22-2014 125
126. The placenta is able to select those substances required by the
fetus, even depleting the mother’s own supply in some instances.
Storage –
Metabolizes glucose and can also stores it in the form of
glycogen and reconverts it to glucose as required.
The placenta store iron and the fat soluble vitamins.
By Alemyehu T March 22-2014 126
127. Excretion
The main substance excreted from the fetus is carbon dioxide;
bilirubin will also be excreted as red blood cells are released
relatively frequently.
Protection –
It provides a limited barrier to infection with the exception of
the treponeona of syphilis and, few bacteria can penetrate.
Viruses, however, can cross freely and may cause congenital
abnormalities as in the case the rubella virus and HIV virus.
By Alemyehu T March 22-2014 127
128. Endocrine –
Human chorionic gondotroghin (HCG) is produced by the
synicytotrophoblast layer of the chorionic villi.
By Alemyehu T March 22-2014 128
129. The placenta is completely formed and
functioning from 10weeks after fertilization.
Between 12 and 20 weeks gestation the placenta weighs
more than the fetus.
Fetal blood, low in oxygen, is pumped by the fetal heart
towards the placenta along the umbilical arteries.
Having absorbed oxygen the blood is returned to the fetus
via the umbilical vein.
By Alemyehu T March 22-2014 129
130. The placenta measures about 20 cm in diameter and 2.5cm
thick from its center.
It weighs approximately one sixth of the baby’s weight at term.
It has two surfaces.
1. Maternal surface
2. Fetal surface
By Alemyehu T March 22-2014 130
131. 1. The maternal surface
maternal blood gives this surface a dark red colour and part of
the basal decidua will have been separated with it.
The surface is arranged in about 20 lobes which are separated
by sulci
By Alemyehu T March 22-2014 131
132. 2 The fetal surface.
The amnion covering the fetal surface of the placenta
gives it a whitish, shiny appearance.
Branches of the umbilical veins and arteries are visible and
spreading out from the insertion of the umbilical cord
which is normally in the center.
Chorion – Outer layer adhere to the uterine wall.
Amnion -The inner layer of the amniotic sac containing
an amniotic fluid and cover the fetal surface of the
placenta and are what give the placenta its typical shiny
appearance.
By Alemyehu T March 22-2014 132
133. The total amount of amniotic fluid is about 1 litter and
diminished to 800ml at 38 weeks of gestation (term).
If the total amount exceeds 1500 ml, the condition is known as
polyhdramnous and
If less than 300ml it is known as oligohydraminios.
It constitutes 99% water and the remaining 1% is dissolved
organic maters including substances and waste products.
By Alemyehu T March 22-2014 133
134. Functions of amniotic fluid
Allows for free movement of the fetus.
Protects the fetus from injury.
Maintains a constant temperature for the fetus
During labour it protects the placenta and umbilical cord from
the pressure of uterine contraction
Aids effacement and dilation of the cervix
By Alemyehu T March 22-2014 134
135. The umbilical cord or funis extends from the fetus to the
placenta and transmits the umbilical blood vessels, two arteries
and one vein.
These are enclosed and protected by Wharton’s jelly, (a
gelatinous substance formed from mesoderm).
The whole cord is covered in a layer of amnion continuous with
that covering the placenta.
The length of the average cord is about 50cm.
A cord is considered to be short when it measures less than
40cm.
By Alemyehu T March 22-2014 135
136. There is no mixture between maternal & fetal blood.
The fetus in utero has its own circulatory system which is
immature & different from adult circulation.
The fetus produces its own red & white blood cell.
During intra uterine life; the fetal gastro intestinal &
respiratory system are not functioning.
By Alemyehu T March 22-2014 136
137. There are four temporar y structures
•Ductus venosus: This vessel carries oxygenated blood from the
umbilical vein to the inferior venacava.
•Foramen ovale an opening between the two atria of the fetal
heart.
•Ductus ar teriosus - connect the pulmonary artery to the
descending arch of the aorta.
•Hypogastric ar tery : These are branches of the internal iliac
artery. They return impure blood back to the placenta.
By Alemyehu T March 22-2014 137
138. CIRCULATION
The umbilical vein - leads from the umbilical cord to the
underside of the liver carries blood rich in O2 & nutrients. But
before it reaches to the liver ducts venous gives off to join the
inferior venacava.
Here, there is a mixture oxygenated & deoxygenated blood from
the lower limp.
The blood enters the right atrium of the heart and passes
through an opening known as foramen ovale in to the left atrium.
By Alemyehu T March 22-2014 138
139. The blood now passes from the left atrium into the left ventricle
through the mitral valve & is pumped out through the Aorta.
The impure blood from the head & upper limbs enter the right
atrium through the superior venacava.
Passing through the tricuspid valve, into the right ventricle,
which it leaves by the pulmonary artery.
By Alemyehu T March 22-2014 139
140. Since the lungs are inactive the blood will pass through the
Ductus arteriosus (which connects the pulmonary artery to the
aorta.
Then the descending aorta supplies the abdominal organs &
lower limbs
The deoxygenated blood then returned to the placenta through
the umbilical arteries
Hypogastric arteries, it branches off from the internal iliac
arteries.
By Alemyehu T March 22-2014 140
141. When the hypo gastric arteries reach to placenta joins the
umbilical cord & becomes the two umbilical arteries.
Hypo gastric arteries are the only artery which carries unmixed
blood.
By Alemyehu T March 22-2014 141
143. At birth the baby takes breath & blood is drawn to the lung
through the pulmonary arteries & returned by the pulmonary
vein to left atrium.
And the placental circulation ceases after birth & less blood will
return to right side of heart.
In this way the pressure in the left side of the heart is greater
than the right side of the heart which causes closure of foramen
ovale then flow of blood from right side to left side of heart
will be stopped.
By Alemyehu T March 22-2014 143
144. The cessation of the placental circulation results in the collapse
of umbilical vein, Ductus venous & Hypogastric arteries.
These vessels after collapse changes to the following structure.
By Alemyehu T March 22-2014 144
145. The umbilical vein The ligamentum teres
The Ductus venousus The ligamentum venosum
The Ductus arteriosus The ligamentum arteriosum
The foramen ovale The fossa ovalis
TheHypogastric arteries the obliterated Hypogastric arteries
By Alemyehu T March 22-2014 145
146. • Defn: - Antenatal care is a medical( treatment of anemia,
HTN, STD) and general care(psychological) that is provided
to a woman during her pregnancy.
By Alemyehu T March 22-2014 146
147. To promote & maintain good health of the mother & fetus
during pregnancy.
To ensure that the pregnancy results in a healthy infant &
healthy mother.
To detect early & treat appropriately ‘high’ risk conditions
(medical or obstetrical).
To prepare the women for labor, lactation & the subsequent
care of the baby.
By Alemyehu T March 22-2014 147
148. Gravidity – refers to the number of Pregnancy
Primigaravida - a woman pregnant for the first time.
Multig ravida - a woman who has had two or more
pregnancies.
Parity - Refers to delivery above 28 weeks of gestation.
Nulipara - a woman who has not given birth to a child.
By Alemyehu T March 22-2014 148
149. • Multipara - a woman who has given birth two times or more.
• Grand multipara - women who has given birth five or more
children
• Lie - is the relationship of the long axis (spine) of the fetus to
the long axis of the mother’s uterus.
There are 3 lies:
-longitudinal --normal
-Transverse --Abnormal
-Oblique
By Alemyehu T March 22-2014 149
150. • Attitude: is the relationship of the fetal parts to one another,
(head & limp to its trunk),
There are 3 attitude;
-Flexion -- normal
- Extension --Abnormal
-Military ordeflection
By Alemyehu T March 22-2014 150
151. • Presenting par t - is the part of the fetus felt at the lower
pole of the uterus & felt on abdominal examination and on
vaginal examination.
• Presentation - is the part of the fetus in the lower pole of the
uterus & the normal presentation is vertex,
By Alemyehu T March 22-2014 151
152. abnormal presentations are ;
Breach
Face
Brow &
Shoulder
By Alemyehu T March 22-2014 152
156. • Position: is the relationship between the denominators of the
presentation to the six areas of the mother’s pelvis ( pelvic brim
land marks).
Normal position is Occcipito anterior but abnormal
(Malposition) is Occcipito posterior position
By Alemyehu T March 22-2014 156
160. • Denominator-The part of the fetus which determines the
position
Vertex - Occiput
Breech - Sacrum
Face - Mentum
Brow – glabella
Shoulder – scapula
By Alemyehu T March 22-2014 160
161. • Positions of ver tex presentation.
Left Occipito anterior (LOA) - the occiput points to
the left Iliopectineal eminence. The sagital suture is on the
right oblique diameter.
Right Occipito anterior (ROA) - the occiput points
to the right Iliopectineal eminence. The sagital suture is in
the left oblique diameter of the pelvis.
By Alemyehu T March 22-2014 161
162. Left Occipito lateral (LOL) - The occiput points to the
left Iliopectineal line mid way between the Iliopectineal
eminence & the sacroiliac joint. The sagital suture is in the
transverse diameter.
Right Occipito lateral (ROL) - The occiput point to the
right Iliopectineal line midway between Iliopectineal eminence
& Sacro iliac joint. The sagital suture is in the transverse
diameter of the pelvis.
By Alemyehu T March 22-2014 162
163. Left Occipito posterior (LOP) –
The occiput points to the left sacroiliac joint.
The sagital suture is in the left oblique diameter of the pelvis.
Right Occipito posterior (ROP) –
The occiput point to the right sacroiliac joint.
The sagital suture is in the right oblique diameter of the pelvis.
By Alemyehu T March 22-2014 163
164. Direct Occipito anterior (DOA) –
The occiput points to the symphysis pubis.
The sagital suture is in the anterior posterior diameter of the
pelvis.
Direct Occipito posterior (DOP) –
The occiput points to the sacrum, the sagital suture is in the
anterior posterior diameter of the pelvis.
By Alemyehu T March 22-2014 164
165. • Engaged - When the biparietal diameters of the fetal head
passes through the pelvis brim.
By Alemyehu T March 22-2014 165
166. There are two different models of ANC:
1. Traditional or standard or western model
2. WHO ANC model
By Alemyehu T March 22-2014 166
167. This type of model is recommended for pregnant mother by
dividing those mothers in to two categories depending on
different features
Risk group
Non-risk group
By Alemyehu T March 22-2014 167
168. This model is focuses on disease prediction rather than disease
detection.
In addition to the above issues the model is also planned a
number of subsequent visits to allow accurate dating of
pregnancy and appropriate preventive and therapeutic
interventions.
By Alemyehu T March 22-2014 168
169. The frequency and timing of western ANC model is;
1st visit ---as early as the first missed period.
Thereafter, subsequent visits are planned every 4 weeks until
28 gestational weeks.
Every 2 weeks b/n 28-36 gestational weeks.
Every weeks after 36 gestational weeks.
By Alemyehu T March 22-2014 169
170. It is also named as focused antenatal care model.
The main thing here is that disease detection rather than disease
prediction.
It limits the number of visits and restricts laboratory tests and
procedures.
By Alemyehu T March 22-2014 170
171. Focused ANC recommends a minimum of four visits:
1st visit---takes place at 16 gw or before.
2nd visit--- planned b/n 24-28 gw.
3rd visit--- planned b/n 30-32 gw.
4th visit---at 36-38 gw.
By Alemyehu T March 22-2014 171
173. Major activities are:
Diagnosis of pregnancy and determination of the gestational
age;
Risk assessment and determination of the medical status of the
mother;
Health promotion by education on nutritional supplement,
danger signs of pregnancy and
Finally care provision like malaria prophylaxis, control MTCT
of HIV, iron supplementation and immunization with tetanus
toxoid.
By Alemyehu T March 22-2014 173
174. • Major activities are;
Screening for hypertension, multiple gestation, anemia, preterm
labor, diabetes mellitus and RH sensitization;
Further health promotion and care provision and
Plan birth place.
By Alemyehu T March 22-2014 174
175. • Major activities are;
Screening for hypertension, anemia, multiple pregnancy,
diabetes mellitus and RH sensitization;
Health promotion and care provision and
Plan birth place.
By Alemyehu T March 22-2014 175
176. • Major activities are;
Screening for hypertension, APH, multiple gestations;
Check for fetal lie, presentation, growth and well being;
Health promotion and care provision and
Finally up date individualized birth plan.
By Alemyehu T March 22-2014 176
177. I. Assessment
II. Health promotion
III. Care provision
Assessment contains:-
History
Physical examination &
Laboratory investigations
By Alemyehu T March 22-2014 177
178. 1.Identification
Name
Age
Marital status
address
Religion
occupation
Date of admission
Ward and bed number
By Alemyehu T March 22-2014 178
179. 2. Chief complaints
Patients may have come for routine ANC follow up or may
come with one or more specific complaints with its duration.
E.g. amenorrhic for the last 2 months.
lower abdominal pain for the last 3days.
vaginal bleeding for the last 2 days.
By Alemyehu T March 22-2014 179
180. 3.Histor y of present pregnancy
Get information on the following points:
• Gravidity
• Parity
• abortion
• Last menstrual period(LMP)
By Alemyehu T March 22-2014 180
181. • Expected date of delivery(EDD)
w/c could be calculated by:
a) Naegale’s rule(using European calendar)
LNMP-3onths+7days
b) Ethiopian calendars
NLMP+9months +10days if pagume is not passed
NLMP+ 9months+5 if pagume is passed
By Alemyehu T March 22-2014 181
182. • Gestational age
w/c is calculated by :
subtracting NLMP from date of admission and put the
result by weeks and days.
• fetal quickening
• Presence of ANC else where ,place and number of visits
• Elaboration of chief complaints
By Alemyehu T March 22-2014 182
183. • Danger symptoms of pregnancy like:
Vaginal bleeding
Severe headache
Blurring of vision
Epigastric or severe abd.pain
Profuse v/discharge
Absence or reduction of fetal mov’t
Fever
Persistent vomiting
By Alemyehu T March 22-2014 183
184. • Common complaints of px.(minor symptoms)
• Pregnancy –unwanted, unplanned and unsupported
By Alemyehu T March 22-2014 184
185. Should be asked for all previous px:
• Date, month and year of gestation
• Length of gestation
• Significant antenatal medical problems like:
HPN,APH,DM…
• Onset of labour(spontaneous or induced)
• Fatal presentation
• Duration of labour
• Mode of delivery
• Fetal out come
• Post partum complications like:BPy APlemHyehu T March 22-2014 185
186. FP methods -use, type, duration and side effects
Sexual history-assess risk of STI and HIV/AIDS
Gynaecology operations-FGM, laparotomy, dilatation and
curettage and manual vacuum aspiration.
Menstrual history(age of menarche, interval of period 21-36
days, amount of flow 10-80ml,duration of flow 1-8 days,
normally dark red and non-clotting)
By Alemyehu T March 22-2014 186
187. Blood transfusion important in haemolytic disease of new born
Drugs risk of teratogenicity or allergic rxns.
Hx of DM ,HPN, hypo or hyperthyroidism w/c may the
affect px or get aggravated by px.
Maternal infection-TORCH syndrome
By Alemyehu T March 22-2014 187
188. Childhood dev’t
Educational status
Habits like alcohol, smoking and elicit drugs
Occupation-exposure to radiation, anaesthesia, chemical
factory and others
Income-low socio-economic status associated with obstetric
problems like preeclampsia, preterm labour
Family history-DM, HPN, multiple px, genetic disorders
8.Review of systems
• Check all systems
By Alemyehu T March 22-2014 188
189. Examination must be done in private room.
Proper explanation must be offered to the patient before,
during and after the examination.
Bladder should be emptied and the patient properly positioned
on the couch.
Warm hands and instruments must be used.
Adequate light, appropriate gloves and swabs should be
prepared.
Always keep eye contact throughout the examination.
By Alemyehu T March 22-2014 189
190. 1. General appearance
• As she walks in, observe any deformity, stunted growth
• Does she look well or pale & tired?
2. Vital signs and anthropometric measurements
• Blood pressure
- Check and record at each visit
- Relative rise of 30 mmHg systolic of 15 mmHg diastolic is
one of the early signs of pre -eclampsia
By Alemyehu T March 22-2014 190
191. • Pulse rate -increases 10-15 beats/minute in
pregnancy
• Respiratory rate -increases 1-4 breath /minute in
pregnancy
• Weight – increment 12kg/pregnancy
By Alemyehu T March 22-2014 191
192. 3. HEENT
• Emphasis on conjunctiva, sclera, teeth and buccal mucus
membrane to see pallor, jaundice, mucosal congestion and
dental carries.
4. Lymphoglandular system
• Thyroid gland for hyper or hypo thyroidism signs
By Alemyehu T March 22-2014 192
193. 5. Breast examination
Asses the size of any lump in the breast by dividing into four
quadrant and find any mass starting from QI-IV by your
dominant fingers and supporting with the another hand
Asses for nipple refraction, pigmentation, lumps, discharge,
colour discharge.
Nipples are inverted or flat ,if the nipple are flat tell the
mother to roll several times a day
Teach the mother self examination of the breast
By Alemyehu T March 22-2014 193
194. • Steps in examination are essentially same as non pregnant
patient
By Alemyehu T March 22-2014 194
195. AIMS
• To estimate the size of the uterus/fetus
• To find out lie /presentation
• To asses fetal health/fetal heart sound FHB)
• To diagnose the location of the fetal parts
• To detect any deviation from normal
By Alemyehu T March 22-2014 195
196. Steps for abdominal examination
– Inspection
– Palpation
– Auscultation
By Alemyehu T March 22-2014 196
197. • Shape
– Note contour is it round oval irregular or pendulous
– Longitudinal ovoid in primigaravida
– Round in multi gravida(a big round uterus may be due to
multiple pregnancy transverse lie ,hydroaminions or
obesity)
– Broad in transverse lie
• Size
• should correspond with the estimated period of gestation
By Alemyehu T March 22-2014 197
198. • Skin- the dark line which is linea nigra- midline hyper
pigmentation due to melanocyte stimulating hormone .
• stirae gravidarum- purplish in new Striae and white in old
Striae. In both cases is due to distension, which causes
stretching.
• Scar any operation scar (c/s)
By Alemyehu T March 22-2014 198
199. • Superficial palpation – checks for rigidity, tenderness,
superficial mass and characterize it ,abdominal wall defects.
• Deep palpation – palpate for mass, organomegaly and
characterize the mass
• Obstetric palpation or Leopold’s maneuver
By Alemyehu T March 22-2014 199
200. A. The first Leopold maneuver or fundal palpation
I. Fundal height measurement:
• first correct for asymmetry before measurement.
• Then use one of the following methods:
Finger method – one finger above umbilicus is equal to two
weeks and below umbilicus one finger is equal to one week.
By Alemyehu T March 22-2014 200
201. • Uterus felt at symphysis corresponds to 12 weeks.
• At the umbilicus it is 20 weeks and at xiphysternum it is 38
weeks.
Tape measurement: symphysis to fundal height in
centimeter with tape meter between 18-34 weeks is accurate to
within two weeks of actual gestational age.
By Alemyehu T March 22-2014 201
202. Is assessment and monitoring the fetal behaviors and well
being
It is offered to detect early signs of uteroplacental
insufficiency and hypoxia.
Methods of antenatal fetal assessment
Clinical method /fetal movement
Ultrasound
Bioelectrical method
Biophysical profile
Biochemical profile
By Alemyehu T March 22-2014 202
203. The mother asked to count the fetal movement
First quickening of the fetus is recognized at 18-20 weeks in
primigravida and at 16-18 weeks in multigravida
The fetal movement is accepted if it is ≥6 kicks/2hours or 2-3
kicks/hour
If <6 kicks,the mother is asked to :
Eat/drink
Change her position
Go to quite room and count for another 2 hours
By Alemyehu T March 22-2014 203
204. D –death of fetus
A-amniotic fluid decreased
S –sleep
H –hunger/thrist
Fetal movement is good indicator of placental function
By Alemyehu T March 22-2014 204
205. Estimation of gestational age
Done in first trimester(best between 8-12 weeks)
Measurement of crown-rump-length (CRL) error-±3 days
Nuchal translucency u/s
Done at 11th -14th weeks gestation
Measures the amount of amniotic fluid behind the
neck of the fetus
Used for screening fetal abnormalities. ex Down’s
syndrome
By Alemyehu T March 22-2014 205
206. Fetal g rowth and anatomy
Routinely done 18th -20th weeks (error-7days)
Routine 2nd trimester us
Done 18th -22th weeks
Helps to determine numbers fetus,gestation,location of
placenta ,fetal anomalities
By Alemyehu T March 22-2014 206
207. Non-stress test (NST) ;external Doppler used to record
the fetal heart rate and its relationship to fetal movement
The is no stress applied on fetus;so it is called NST
Indication ;any suggestion of utroplacental insufficiency
There are two scales NST chart:
Upper chart –record FHR and lower chart –record uterine
contraction
By Alemyehu T March 22-2014 207
208. Characteristics of normal FHR
Hear t rate: (100-180) hospital setting
Heart rate (120-160) health center setting
Variability: due to the effects of vagus nerve
Shor t term variability ; from beat to beat
Long term variability ; fluctuate over 1’
Decreased variability ; >40’,need to assess the
fetal well being
By Alemyehu T March 22-2014 208
209. Acceleration ; it is increases of FHR above base
line
It may occurs in response to fetal movement
Normal acceleration in 20’is atleast acceleration
wich is bpm above base line ,lasting for ≥15”
If all previous parameters are normal and called
reactive NST ;if not;it is called non reactive
NST
The test done at 28th week
By Alemyehu T March 22-2014 209
210. Contraction stress test ;demonstrate the
relationship between the FHR and uterine
contraction
It is done when hypoxia suspected after NST
In this test,the uterine contraction are
stimulated drugs /manipulation of nipple
Normally ;there is no change in the FHR
If there is late deceleration ;indicates placental
insufficiency
If there is variable deceleration;indicates cord
compression
By Alemyehu T March 22-2014 210
211. It consists of a 30’ assessment of fetus
The following parameters are recorded using
U/S
Amniotic fluid volume
Fetal breathing
Fetal movement
Fetal tone
By Alemyehu T March 22-2014 211
212. Indications :it is the test of choice for
Non-reassuring NST
Post term pregnancy
Decreased fetal movement
Any suggestion of fetal distress/
Uteroplacental insufficiency
By Alemyehu T March 22-2014 212
213. Parameters Normal points(2) Abnormal (0)
1.Amniotic
Fluid pocket ≥2 ≤2
fluid volume
2.Breathing Atleast one episode
lasting for 30”
No breathing
3.Movement Atleast 3 movement of
trunk/limb
No movement/≤2
4.Tone Atleast one episode limb
extension followed by
flexion
No movement
By Alemyehu T March 22-2014 213
214. The total sum points for the parameter is
calculated :
8 points ;normal fetus and BPP
6 points;border line
4-0 points urgent inter vention needed
NB:Maternal hypoglycemia may affect the results
of BPP
By Alemyehu T March 22-2014 214
215. Triple marker screen
Done in 2nd trimester (15th -20th weeks)
Used to detect trisomy 21(Down’s syndrome),
trisomy 18(Edward’s syndrome), trisomy
13(Platau syndrome
March 22 By Alemyehu T -2014 215
216. Quadruple marker screen
The 3 markers of triple serum screen +inhibin A
This increases the rate of detection of Down’s syndrome
up to 80%
Surfactant is a phospholipids consists of
lecithin$sphingomyelin
By Alemyehu T March 22-2014 216
217. These phospholipids can be measured in amniotic fluid
The surfactant is good when the ratio of
lecithin/sphingomyelin >2
Moreover ;presence of phosphatidyl-glycerol and
phosphatidyl-choline indicates lung maturity
By Alemyehu T March 22-2014 217
218. uterine Doppler
measures the blood flow in vessels using US
It is used to assess the blood flow in to umbilicus ,uterus
and brain
Useful to detect the conditions impairing the blood flow to
the placenta or fetus eg. HTN, Preeclampsia ,smoking
etc…
these disease may result in IUGR & there fore US is useful
to detect impairment of blood fetus
By Alemyehu T March 22-2014 218
219. contents
Over view
Effects of pregnancy on the course of HIV
Effect of HIV infection on pregnancy
Estimated risk of MTCT of HIV
Factors affecting MTCT of HIV
Interventions to prevent MTCT of HIV
By Alemyehu T March 22-2014 219
220. Introduction:?
◦ According to the calibrated single point estimate (2011),
the national adult HIV prevalence is reported to be 1.5
% (4.2 % in urban and o.6% in rural areas).
◦ 1,216,908 Ethiopians are living with HIV AIDS (41%
male, 59% females).
◦ An estimated 38,404 HIV positive pregnant women are
anticipated in 2012.
By Alemyehu T March 22-2014 220
221. ◦ Highest prevalence occurs with 30 – 34 years of age
group and prevalence is higher among females than males,
both among urban and rural areas.
◦ Prevalence appears to have leveled in urban areas but
continued to rise in rural areas, where 85% of population
l
By Alemyehu T March 22-2014 221
222. Of 40 million people living with HIV/AIDS worldwide,
17.5 are women (2009)
77% of all women living with HIV are in sub-Saharan
Africa (2009)
Among HIV positive adults, women account for 57% in
sub-Saharan Africa, 26% in southeast Asia, 27% in
Europe, and 25% in the US (2009)
By Alemyehu T March 22-2014 222
223. Biological
Economic
Social
Cultural
“Women are most vulnerable to HIV infection, given the
social and economic disadvantages they face in their day to
day lives.”
By Alemyehu T March 22-2014 223
224. 80 % of HIV infected women are of childbearing age
Possible route of HIV transmission
I. sexual contact
II. parentral exposure to blood and body fluid.
III. from mother to child
antepartum
intrapartum
post partum
By Alemyehu T March 22-2014 224
225. Pregnancy itself does not affect the outcome of HIV
infection unless in late stage
Progression from asymptomatic infection to AIDS is
uncommon in pregnancy
So, the existence of a short term synergistic effect on the
immune system between pregnancy and HIV infection is
not supported
By Alemyehu T March 22-2014 225
226. spontaneous abortion
ectopic pregnancy
preterm labor
abruptioplacentae
low birth weight baby
stillbirths
postpartum infectious complications,
particularly after C/S.
MTCT
By Alemyehu T March 22-2014 226
227. PMTCT is a term used to describe a package of services
intended to reduce the risk of mother-to-child transmission
of HIV.
With out intervention the risk of MTCT is 20-45%
By Alemyehu T March 22-2014 227
228. Estimated Risk of MTCT
Timing
Transmission Rate Without
Any Interventions
During pregnancy 5-10%
During labor and delivery 10-15%
During labor and delivery 5-20%
Overall without breastfeeding 15-25%
Overall with breastfeeding to six months 20-35%
Overall with breastfeeding to 18-24 months 30-45%
By Alemyehu T March 22-2014 228
229. Viral Load
◦ The higher the viral load, the higher the risk of MTCT
Lower risk through:
◦ Use of ART during pregnancy and postpartum to
mother and newborn
◦ Adequate nutrition, particularly vitamin A?
By Alemyehu T March 22-2014 229
230. Maternal factors increasing risk:
◦ Viral or parasitic placental infection (especially malaria)
◦ Becoming infected with HIV during pregnancy
◦ Severe immune deficiency
◦ Advanced clinical and immunological state
◦ Maternal malnutrition
By Alemyehu T March 22-2014 230
231. Labor and delivery factors increasing risk:
◦ Prolonged rupture of membranes (>4 hours)
◦ Injury to birth canal during child birth
◦ Antepartum procedures
◦ Acute chorioamnionitis
◦ Invasive fetal monitoring
◦ Instrumental delivery
◦ Mixing of maternal and fetal body fluids
◦ Delayed infant cleaning and eye care
◦ Routine infant airway suctioning
By Alemyehu T March 22-2014 231
232. Primary prevention of HIV in childbearing women
Prevention of unintended pregnancy in HIV-positive
women
Prevention of transmission from HIV+ women to
their infants
Treatment, care and support of women infected
with HIV, their infants and their families
By Alemyehu T March 22-2014 232
233. Health education
Screening for anemia and micronutrient supplementation
Screen and treat STDs in pregnant women
Malaria chemoprophylaxis
Family planning counseling
Screen for TB
Reduce maternal viral load using currently recommended
regimens of antiretroviral drugs.(option B+)
History , examination and investigations in each ANC visits
By Alemyehu T March 22-2014 233
234. Routine counseling for all
VCT
ARV
Infant feeding counseling
Referral for care and support
Comprehensive package of care (ANC, delivery and
postnatal care, child care, family planning)
Male partner involvement strategy
Community mobilization
Support group
Written implementation protocols
By Alemyehu T March 22-2014 234
235. Mothers in need of ART for their own health should get
lifelong treatment
Initiate ART in pregnant women with CD4<350
regardless of clinical stage
Initiate ART in clinical stage 3 and 4 if CD4 not available
Start ART as soon as feasible
Importance and critical need of CD4 for decision-making
on ART eligibility
By Alemyehu T March 22-2014 235
236. Option A Option B
Mother
• Antepartum AZT (from 14 weeks)
• sd-NVP at onset of labour*
• AZT + 3TC during labour & delivery*
• AZT + 3TC for 7 days postpartum*
Infant
Breastfeeding population
•Daily NVP (from birth until one wk after
all exposure to breast milk had ended)
Non-breastfeeding population
•AZT for 6 weeks OR
•NVP for 6 weeks
Mother
• Triple ARV (from 14 wks until one
wk after all exposure to breast milk has
ended)
• AZT + 3TC + LPV-r
• AZT + 3TC + ABC
• AZT + 3TC + EFV
• TDF + XTC + EFV
Infant
All exposed infants
• AZT for 4-6 weeks OR
• NVP for 4-6 weeks
By Alemyehu T March 22-2014 236
237. During pregnacy
TDF/3TC/EFV
Continue HAART if already initiated
During delivery and labor
if HAART continue
women present for the first time start TDF/3TC/EFV
women who are in option A will be transitioned to
OPTION B PLUS
By Alemyehu T March 22-2014 237
238. Lactating and post partum
continue ART if started
initiate ART if not on treatment
if women was in option A treatment change to OPTION B
plus
Infant
NVP for six weeks post partum
By Alemyehu T March 22-2014 238
240. Follow recommended infection prevention practices
◦ Wash hands thoroughly before and after each procedure
and examination
◦ Wear hand and eye protection
◦ Handle needles and other sharp instruments safely
◦ Dispose placenta and other waste materials and supplies
properly
◦ Process instruments, gloves and other items by
decontamination, cleaning and either sterilization or
high-level disinfection
By Alemyehu T March 22-2014 240
241. Minimize vaginal examination
Use partograph to monitor labor
AVOID
Routine rupture of membranes
Prolonged labor
Unnecessary trauma during childbirth
Minimize risk of postpartum hemorrage
Use safe transfusion practice (blood screened for HIV,
Syphilis,malaria,hepatitisB and C when possible
By Alemyehu T March 22-2014 241
242. We need to follow the mother
Clean genitalia with savlon
Avoid invasive procedure like( episiotomy ,vacuum or
forceps)
By Alemyehu T March 22-2014 242
243. Elective caesarean section
Consider elective caeserean delivery when safe and
Feasible
Done before the onset of labor or membrane rupture
Do C/S if there is active HSV
By Alemyehu T March 22-2014 243
244. Cesarean section before onset of labor and membrane
rupture decreases risk of MTCT 50–80%
No evidence of benefit after onset of labor or
membrane rupture
By Alemyehu T March 22-2014 244
245. Special concerns with cesarean section in limited-resource
settings
◦ Increased maternal morbidity and possible mortality
◦ Availability of blood and blood safety
◦ Antibiotic prophylaxis
◦ Anesthesia availability
◦ Limited human resources — nursing care time
By Alemyehu T March 22-2014 245
246. Cut cord under the cover of gauze
Determine mothers feeding choice
Administer vitamin k
Administer the first vaccines
Do not
-suction unless meconium stained liquor is
present
By Alemyehu T March 22-2014 246
247. Tenascin-C is an innate broad-spectrum,HIV-1 –
neutralizing protein in breast milk.
TNC is directed against the virus and not the target cell
TNC concentration range of 2.2–671 μg/mL
TNC was able to block up to 66% of infectious
By Alemyehu T March 22-2014 247
248. Monitoring adherence
Follow up
Grading and managing adverse effect
Managing drug –drug interaction
Giving preventive service
Nutritional support
By Alemyehu T March 22-2014 248