A normal pregnancy lasts about 40 weeks and is divided into three trimesters. The first trimester is weeks 0-12, the second is weeks 13-28, and the third is weeks 29-40. Signs of pregnancy include missed periods, breast changes, nausea, frequent urination, and darkening of the skin. Positive signs that confirm pregnancy are a positive urine test, visualization of the fetus by ultrasound, and detection of the fetal heartbeat with Doppler or fetoscope from 10 weeks onward.

1. Normal Pregnancy
Prepared By
Janula Raju
Faculty of Maternity Nursing
King Khalid University,
KSA

2. Duration of pregnancy
 A normal pregnancy lasts about 40
weeks and is grouped into three stages,
or trimesters.
 First Trimester: 0-12 weeks
 Second trimester: 13-28 weeks
 Third trimester: 29-40 weeks

3. What is gestational age?
The duration of pregnancy
calculated from the first day of last
menstrual period. Usually it is 40
weeks or 280 days. This is called
menstrual age or gestational age.

4. Reproductive System Changes
 Reproductive tract changes are those
involving the uterus, ovaries, vagina, and
breasts.
Uterine Changes:
Over the months of pregnancy, the
uterus increases in length, depth, width,
weight, wall thickness, and volume.

5.  Length - 6.5 to 32 cm.
 Width - 4 to 24 cm.
 Weight increases from 50 to 1000 g.
 Early in pregnancy, the uterine wall thickens
from about 1 cm to about 2 cm;
 end of pregnancy, the wall thins to 0.5 cm
thick.
 The volume of the uterus increases from
about 2 ml to more than 1000 ml.

6.  end of the 12th week, - palpated just above the
symphysis pubis.
 20th or 22nd week - at the level of the umbilicus.
 36th week- it should touch the xiphoid process and can
make breathing difficult.
 About 2 weeks before term (the 38th week) for a
primigravida, a woman in her first pregnancy, the
fetal head settles into the pelvis and the uterus returns
to the height it was at 36 weeks. This event is termed
lightening,

8. Lightening

9. What is Hegar’s sign?
 At about the sixth week of pregnancy
the lower uterine segment just above
the cervix becomes so soft.
 This extreme softening of the
lower uterine segment is
known as Hegar’s sign

10. What is Braxton Hicks contractions?
 Uterine contractions begin early in
pregnancy, at least by the 12th week,
and are present throughout the
pregnancy. They may be felt by a
woman as waves of hardness or
tightening across her abdomen. It is
also called as painless uterine
contraction.

11. Amenorrhea
 Amenorrhea (absence of
menstruation) occurs with pregnancy
because of the rising estrogen levels.

12. Cervical Changes
 Increased vascularity causes Softening of
the cervix in pregnancy (Goodell’s sign) is
marked.
 The consistency of a nonpregnant cervix
may be compared with that of the nose,
whereas the consistency of a pregnant
cervix more closely resembles that of an

13.  Vaginal Changes: An increase in the
vascularity of the vagina, changes the
color of the vaginal walls from the
normal light pink to a deep violet.
(Chadwick’s sign),
 Ovarian Changes: Ovulation stops with
pregnancy

14. Ovarian Changes
 Ovulation stops with pregnancy
because of the active feedback
mechanism of estrogen and
progesterone produced by the corpus
luteum early in pregnancy and by the
placenta later in pregnancy

15. Changes in the Breasts
 She may experience a feeling of fullness,
tingling, or tenderness in her breasts.
 As the pregnancy progresses, breast size
increases
 By the 16th week, colostrum, the thin,
watery, high-protein fluid can be expelled
from the nipples.

16. Integumentary System
 As the uterus increases
in size, the abdominal
wall must stretch.
 This stretching can
cause pink or reddish
streaks (striae
gravidarum) appearing
on the sides of the
abdominal wall

17.  A narrow, brown line
(linea nigra) may form,
running from the
umbilicus to the
symphysis pubis and
separating the
abdomen into right
and left hemispheres

18.  Darkened areas may
appear on the face as
well, on the cheeks and
across the nose. This is
known as melasma
(chloasma), or the
“mask of pregnancy.”

19. Respiratory System
 The cumulative effect of these
respiratory changes is often
experienced by a woman as chronic
shortness of breath.
 As the uterus enlarges during
pregnancy, a great deal of pressure is
put on the diaphragm and, ultimately, on

20. Temperature
 Early in pregnancy, body temperature
increases slightly because of the
secretion of progesterone from the
corpus luteum.
 As the placenta takes over the
function of the corpus luteum at about
16 weeks, the temperature usually

21. Cardiovascular System
 Changes in the circulatory system are
extremely significant to the health of the fetus.
 Blood Volume.: the total circulatory blood
volume of a woman’s body increases
by at least 30%.
Blood loss at a normal vaginal birth is about 300
to 400 mL; blood loss from a cesarean birth
can be as high as 800 to 1000 mL.

22. Iron, Folic Acid, and Vitamin
Needs.
 Inadequate folic acid levels linked to an
increased risk for neural tube disorders in
fetuses.
 Encourage women to eat foods that are
high in folic acid (e.g., spinach,
asparagus, legumes)
 multivitamin supplementation during
pregnancy and reduced cancers in

23. Neural tube

24. Heart.
 Woman’s cardiac output increases the
heart rate increases by 10 beats per
minute.
 The diaphragm is pushed upward by the
growing uterus late in pregnancy,

25. Blood Pressure
 Blood pressure actually decreases
slightly during the second trimester
because the peripheral resistance to
circulation is lowered as the placenta
expands rapidly.
 During the third trimester, the blood
pressure rises again to first-trimester

26. Supine Hypotension
Syndrome
 When a pregnant woman lies supine, the weight of
the growing uterus presses the vena cava against
the vertebrae, obstructing blood flow from the
lower extremities.
 A woman experiences this hypotension as
lightheadedness, faintness, and palpitations.
 Supine hypotension syndrome can easily be
corrected by having a woman turn onto her side
(preferably the left side),

28. Gastrointestinal System
 50% of women experience some nausea
and vomiting early in pregnancy.
 It is most apparent early in the morning,
on rising,
 This common feeling of nausea usually
subsides after the first 3 months.

29. Urinary System
 A pregnant woman may notice an increase
in urinary frequency during the first 3
months of pregnancy, until the uterus rises
out of the pelvis and relieves pressure on
the bladder.
 Frequency of urination may return at the
end of pregnancy, as lightening occurs
and the fetal head exerts renewed

30. Skeletal System
 As pregnancy advances, there is a
gradual softening of a woman’s pelvic
ligaments and joints to create pliability
and to facilitate passage of the baby
through the pelvis at birth.

31. Endocrine System
 Estrogen causes breast and uterine
enlargement.
 Progesterone has a major role in maintaining
the endometrium, inhibiting uterine
contractility, and aiding in the development of
the breasts for lactation.
 Relaxin,is responsible for helping to inhibit
uterine activity and to soften the cervix

32.  HCG stimulates progesterone and
estrogen synthesis in the ovaries until
the placenta can assume this role.
 HPL, is also produced by the placenta.
which allows more glucose to become
available for fetal growth.

33. Signs of
Pregnancy

35. Signs of Pregnancy
Presumptive: possible signs,
Appear in first trimester, often only
noted subjectively by the mother (e.g.,
breast changes, amenorrhea, morning
sickness)

36. Probable: likely signs,
Appear in first and early second
trimesters, seen via objective criteria,
but can also be indicators of other
conditions (e.g., hydatidiform mole)

37. Positive: proof exists
That there is a developing fetus in any
trimester; objective criteria seen by a
trained observer and/or diagnostic
studies (e.g., ultrasound)

38. Presumptive Signs of
Pregnancy
 Amenorrhea. Amenorrhea, the
absence of menstruation, is often one
of the first indications of pregnancy. A
missed menstrual period, however,
does not always signify conception.

39. Nausea.
 Although it is sometimes called
“morning sickness,” the nausea or
vomiting of pregnancy may happen
at any time during the day.
 Hyperemesis gravidarum.: Excessive
vomiting during pregnancy

40.  Frequent Urination. The enlarging
uterus presses against the urinary
bladder. This action may cause the
woman to feel the need to urinate more
frequently than usual.
 Late in the pregnancy, the woman again
feels the need to empty
her bladder frequently.

41.  Fatigue. During the early months of
pregnancy, the woman may feel drowsy
and may tired easily.
 She may find that she requires more
rest and sleep than usual.

42. Quickening.
 The first fetal
movements that the
pregnant woman feels
are called quickening.
The woman usually
experiences
quickening between 18
and 20 weeks of
gestation,

43. Breast Changes.
 The sensations include
enlargement, heaviness, tingling,
throbbing, or tenderness.
 By the 14th week, the woman’s
breasts begin to produce colostrum.

44.  Pigment Changes.: Pregnancy causes
some skin changes. Masking may appear
across the face of dark-haired women.
This is known as melasma (or chloasma
gravidarum), or the “mask of pregnancy.”
 A line of darker pigmentation, known as
the linea nigra, often appears on the lower
abdomen and extends from the umbilicus
to the pubic bone.

45. Probable Signs of Pregnancy
 Basal Body Temperature Elevation.
The body temperature at rest, or basal
body temperature (BBT), rises slightly
(usually less than one degree) as one
of the earliest signs of pregnancy.

46. Positive Urine Pregnancy Tests.
 Pregnancy tests check for the presence of
the hormone called human chorionic
gonadotropin (HCG, HCg, or hCG). This
hormone is produced by the cells that will
become the placenta.
 It can be found in small amounts in a
woman’s urine or blood by about the 7th to
10th day of pregnancy.

47. Urine test
 Pregnancy test video

48. Cervical Changes
 At about the eighth week of gestation, the
cervix softens. This is known as Goodell’s sign.
 Before pregnancy, the cervix feels firm (like the
tip of a nose); during pregnancy, it feels softer
(more like the earlobe).
 The cervix also looks blue or purple when
examined; this is Chadwick’s sign, and may
occur as early as the sixth week of pregnancy.

49.  Uterine Changes.
 At about 6 weeks, the lower uterine
segment (the portion between the
body of the uterus and the cervix)
softens. This softening is called
Hegar’s sign.

50.  Enlargement of the Abdomen. As
the uterus increases in size, the
abdomen is forced outward.

51. Positive Signs of
Pregnancy
 Visualization of the Fetus. A fetus can
be seen either on an ultrasound or, less
commonly, on an x-ray examination.

52. Fetal Heartbeat.
 (fetal heart tones) by using either a Doppler
or a special manual stethoscope called a
fetoscope.
 An examiner can hear fetal heart
tones with the Doppler as early as
the 10th week.

53.  They can be heard with the fetoscope
at about the 18th to 20th week.
 A normal fetal heart rate ranges from
120 to 160 beats per minute.

54. Pinnard Fetoscope

55. Doppler Fetoscope