Topic: Pregnancy, Pregnancy-induced hypertension Faculty: Medicine Course: BSc. ATOT 2nd year Pregnancy: - Signs of pregnancy - Physiological changes in pregnancy - Stages of pregnancy - Estimated Date of Delivery(EDD) - Pregnancy-induced hypertension(PIH) - Preeclampsia - Eclampsia - HELLP syndrome

1. Pregnancy
Dr. Salman Ahmad Ansari
Kanachur Institute of Medical Sciences

2. Contents
● Pregnancy
● Signs of pregnancy
● Physiological changes
● Stages of pregnancy
● EDD
● Hypertensive disorders in pregnancy

3. Pregnancy
- Pregnancy is a state of having implanted products of
conception located either in the uterus or elsewhere in the
body.

4. - It is the period from fertilisation to birth
- Starts when a male sperm fertilises a female egg(ovum) in
the Fallopian tube, forming a zygote with 46 chromosomes
- Zygote starts to divide and forms morula, which reaches
the uterus after 5-7 days, and gets implanted on the wall of
uterus as blastocyst

8. Duration
Normal pregnancy lasts about:
- >280 days
- 9 months
- 40 weeks
- 3 trimesters
- Range of 38-42 weeks

9. Signs of pregnancy
Presumptive signs
Probable signs
Positive signs

10. 1. Presumptive signs
- Absence of menstruation
- Nausea and vomiting common
- Breast tenderness and swelling
- Increased frequency of urination
- Fatigue
- sleepiness

11. 2. Probable signs
These are the physiological and anatomical changes
- Chadwick’s sign: darkness of the vulva
- Goodell’s sign: softening of the cervix and vagina and increase in
discharge
- Hegar’s sign: softening of the lower uterine segment
- Growth of uterus and abdomen
- Skin hyperpigmentation: brownish pigmentation in the face,
darkness of nipple, presence of linea nigra
- Positive pregnancy test result: detection of hcg(human chorionic
gonadotropin) in maternal urine. Tests results are not 100%
confirmatory of pregnancy

12. Chadwick’s sign

13. Goodell’s sign

14. Hegar’s sign

16. 3. Positive signs
- USG signs of pregnancy: double ring sign
- Sonographic visualisation of embryo: cardiac movement
at 4-8 weeks
- Fetal heartbeat: doppler at 10-12 weeks
- Fetal movement: felt after 20 weeks

18. Physiological changes
Pregnancy causes physiologic changes in all maternal organ
systems, most of which return to normal after delivery
- Increased blood supply to breasts and uterus
- Increased level of estrogen and progesterone
- Change in sense of taste and smell, increased salivation
- Softening of joints, increased mobility of sacroiliac joint and
symphysis pubis
- Increased blood volume

19. - Increased requirement of glucose, water, iron and folic
acid due to developing fetus
- Increased respiratory rate
- Increase in size of kidneys and capacity of bladder
- Skin pigmentation
- Gestational hypothyroidism

20. Stages of pregnancy
Divided into three trimesters:
1. 1st trimester(week 1 to 12)
2. 2nd trimester(week 13 to 28)
3. 3rd trimester(week 29 to 40)

21. 1. 1st trimester(week 1 to 12)
During the first trimester, hormonal changes affect almost every organ
system in the body
- Major organs of the baby develop in the first trimester
- Mother stops menstruating
- Extreme tiredness
- Tender, swollen breasts
- Upset stomach
- Craving for certain foods, called “pica”
- Mood swings
- Headaches
- heartburn(reflux)
- These symptoms go away as the pregnancy progresses

22. Changes in the baby:
- brain, heart and spinal cord begin to form
- Heart starts to beat by 4th week of gestation
- Sex organs begin to form
- At the end of 8 weeks, the fetus resembles a human and
is about 2.5 cm
- At 12 weeks, sex differentiation is possible on USG
- Iron and folic acid supplementation: to prevent neural tube
defects

23. 2. 2nd trimester(week 13 to 28)
- Most of the early pregnancy symptoms gradually
subside
- Other symptoms appear, such as backache, limb
swelling and heartburn
- Stretch marks on abdomen and breasts
- Darkening of skin around nipple
- tingling/numbness in hands
- Itching on abdomen, palms and sole of feet

24. - Uterus rapidly grows in size
- Fetus begins to move at about 18-22
weeks(“quickening”)
- Muscle tissue and bone continue to form
- Baby can swallow at 20th week
- Hair begins to grow on body and head at 24th week
- Lungs are formed
- At the end of this trimester, body measures about 30 cm

25. 3. 3rd trimester(week 29 to 40)
- Fetus grows larger and body organs fully develop
- Fetus moves frequently, especially between 27th and 32nd weeks
- Fetus usually settles into a head-down position in the uterus
- Mother experiences shortness of breath
- Swelling of ankles, hands and face
- Heartburn
- Trouble sleeping
- Baby’s eyes can open and close and sense changes in light
- By the end of 37 weeks, baby is considered “full term”
- Near the due date, baby may turn into a head-down position for birth

26. Due date of delivery
Estimated date of delivery(EDD) or Expected date of
confinement(EDC)
Calculated using Naegele’s rule
- To the Last Menstrual Period(LMP), subtract 3
months
- Add 7 days
- Add 1 year
E.g: LMP was on March 8, 2024. What is the EDD?

27. E.g: LMP was on 8th March 2024
Solution:
- Subtract 3 months: 8th December 2023
- Add 7 days: 15th December 2023
- Add 1 year: 15th December 2024
- EDD is 15th December 2024

28. Hypertension in pregnancy
4 disorders:
- Chronic hypertension
- Pregnancy-induced hypertension
- Pre-eclampsia
- Eclampsia

29. Pregnancy-induced hypertension(PIH)
Hypertension occurring after 20 weeks of gestation in a
woman with previously normal blood pressure
SBP >140 mmHg or DBP >90 mmHg
- Also called gestational hypertension
- Can lead to Pre–eclampsia, eclampsia

30. Pre-eclampsia
New onset of hypertension with systolic blood pressure of
140 mm Hg or more or diastolic blood pressure of 90 mm
Hg or more on two occasions at least 4 hours apart,
identified after 20 weeks of gestation, with end-organ
dysfunction
- Complication of PIH
- Dysfunction of end-organs like kidney, liver, CNS, lungs
- Edema, abdominal pain, headache, blurring of vision

32. Treatment of pre-eclampsia:
- Control BP with anti-hypertensives like:
- labetalol(beta blocker)
- nifedipine(calcium-channel blocker)
- hydralazine
- To prevent eclampsia, magnesium sulfate
should be given prophylactically in severe cases

33. Eclampsia
- New onset of generalised tonic-clonic seizures in a
woman with pre-eclampsia
- Severe complication of pre-eclampsia
- Risk to both mother and fetus

35. Treatment of eclampsia:
Medical emergency - requires immediate treatment to
save life of mother and baby
- ABC protocol
- Lay patient on left side
- Magnesium sulfate to control convulsions - loading
dose of 4-6 g iv over 20 minutes followed by
maintenance dose of 2 g/hour for at least 24 hours after
last seizure
- Undergo delivery as soon as possible after stabilisation

36. HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelet count
- It is a type of pre-eclampsia
- Life threatening
- Can occur during late stages of pregnancy and even after
delivery
- Treatment: supportive care, delivery after stabilisation

38. Complications of PIH:
- Pre-eclampsia
- HELLP syndrome
- Eclampsia
- Renal failure
- Intra-uterine growth restriction(IUGR)
- Placental abruption(abruptio placenta): when placenta
detaches from wall of uterus

39. Questions
- Physiological changes in pregnancy
- Name 3 anti-hypertensives in pregnancy
- Complications of pregnancy-induced hypertension

40. References:
● StatPearls for hypertensive disorders
Questions:
salman.s.ansari92@gmail.com
For PPT, scan: