The document summarizes pregnancy diagnosis and the physiological changes that occur during pregnancy. It discusses how pregnancy is diagnosed through hormone detection in urine or blood tests. It then outlines the signs and symptoms of each trimester of pregnancy. Finally, it describes the maternal anatomical and physiological changes that occur in the reproductive, cardiovascular, and respiratory systems to accommodate the growing fetus.

1. PREGNANCY
NAMALOBA

2. Diagnosis of pregnancy:
• The placenta produces a hormone, called
human chorionic gonadotrophin, which is
excreted in the urine.
• This hormone is usually detected in the urine
within a week of the first missed period

3. Diagnosis of Pregnancy
• There are two tests done to test for pregnancy
A blood hCG test- detects even small amounts
A urine hCG test- both at the lab or at home
When can the test be done
• at least 2 weeks after missing periods

4. What can cause a false positive
Evaporation lines – if a urine test is done at home it
should be read within 4-5 minutes
Previous miscarriage or abortion
- In cases of incomplete abortion Hcg is still being
produced
- Post abortion HCG levels remain high for sometime
 molar pregnancy- also known as hydatidiform mole – a
condition that causes uterine tumor
-placenta tissue develops abnormally causing a cluster of
cells or a mass of small fluid sacs
-During this time HCG is produced

5. Medications- some drugs contain synthetic
HCG eg infertility and weight loss drugs
 medical conditions- eg disorders affecting the
pituitary gland , cancers of the ovary, breast
Ovarian cyst

6. 1ST TRIMESTER 0-13wks
• First trimester
Symptoms
– amenorrhea
– morning sickness
– frequency of micturition
– breast discomfort

7. 1ST TRIMESTER
– fatigue
• Signs
– breast changes
– abdominal enlargement
– pelvic changes
Pelvic changes
– Jacquimier’s or Chadwick's sign
– discoloration of vaginal mucosal membrane and
thickening of vagina occurs (4 to 8 weeks)
– Copious non irritating mucoid vaginal discharge

8. 1ST TRIMESTER
• Cervical sign
– softening of the cervix occurs. (at 6th week)
– Cervix becomes elastic also known as Goodle s
sign.
• • Uterine sign
– 6th wk-hen’s egg
– 8th wk-cricket ball
– 12th wk-fetal head

9. 1ST TRIMESTER
• Piskaceck’s sign
– Asymmetrical enlargement of the uterus
Hegar’s sign(6th to 10th week)
• on bimanual examination ,that is P V
examination with right hand and abdomen
with left hand, the examiner feels that both
are touching because of extreme softening

10. 2ND TRIMESTER 14-26
• Symptoms
• • Amenorrhea
• • Quickening
• • progressive enlargement of abdomen
•

11. 2ND TRIMESTER
Signs
• Chloasma (hyperpigmentation of the cheeks
and forehead)
• Breast changes- darkening of the areali
• Linea nigra – line appears btn the umbilicus
and the pelvis
• Striae gravidarum – stretch marks

12. 3RD TRIMESTER 27-40wks
3rd trimester
Symptoms
• Amenorrhea persists
• Progressive enlargement of the abdomen
(85-100cm)
• Lightening-babies head descends into the
pelvis
• Frequency of micturition
• Fetal movements are pronounced

13. 3RD TRIMESTER
Signs
• Cutaneous changes-increased pigmentation
• Uterine shape- water melon
• Braxton Hick’s contraction
• Fetal parts are easily felt
• Palpation of fetal parts are much easier
• Fetal heart sounds heard (may not be audible,
if maternal obesity, polyhydramnios, IUD

14. CLASSIFICATION OF SIGNS OF
PREGNANCY
• Presumptive/possible signs are suggestive of
pregnancy and these signs could be caused by
other conditions. So they do not establish a
diagnosis of pregnancy.
• Probable signs of pregnancy can be observed
by physical examinations. These findings could
also be caused by other conditions.
• Positive signs are physical findings that
establish a diagnosis of pregnancy.

15. Presumptive or possible signs of
pregnancy:
• Amenorrhoea - Absence of menstruation: It is
the first sign and is noticed by the woman herself.
Following implantation, of the fertilised ovum,
the endometrium undergoes decidual change
and menstruation does not occur throughout
pregnancy.
• Morning sickness: Nausea and vomiting along
with or without indigestion occur due to
increased human chorionic gonadotrophic
hormone level.

16. Presumptive or possible signs of
pregnancy:
• Breast changes: Discomfort, tingling and a
feeling of fullness of the breasts may be
noticed as early as third or fourth week of
pregnancy due to increased vascularisation.
• Bladder irritability: Frequency of urination
increases due to pressure from the gravid
uterus and increased vascularity of the
bladder.

17. Presumptive or possible signs of
pregnancy:
• Quickening: A woman’ s first awareness of fetal
movement is called quickening. It is initially felt
between 18 to 20 weeks of gestation. In multigravida it
may be felt from 16 weeks onwards.
Probable signs:
• Presence of HCG in blood and urine between 4 and 12
weeks
• Hegar’ s sign: Softening of isthmus. Isthmus is the part
of uterus between body of uterus and cervix.
• Goodell’ s sign: Softening of cervix.

18. Probable signs of pregnancy:
• Chadwick’ s sign: The color changes from pink to
bluish purplish in the mucous membranes of the
cervix and vagina due to increased
vascularization.
• Osiander’ s sign: Pulsation in fornices felt at 8
weeks. The above signs may develop due to
pelvic congestion also.
• Braxton-Hick’s contractions: Painless, mild
uterine contractions occur from 16th week
onwards, called as Braxton-Hicks contractions.

19. probable signs of pregnancy:
• Changes in the size and shape of abd: From
8th week onwards the size of the uterus
enlarges. Its consistency is soft and become
globular rather than pear shaped.
• Enlargement of the abdomen: The abdomen
enlarges in size as the uterus grows.
•

20. Positive signs of pregnancy:
• Visualization of fetus by x-ray evidence and
ultra sound evidence.
• Fetal heart sounds may be heard as early as
20th weeks
• Fetal movements can be felt per abdomen by
the examiner about 22 weeks onwards.
• Fetal parts can be felt in about 24 weeks
onwards.

21. Maternal physiological changes
during pregnancy
• Reproductive organs:
• Vulva: Vulva becomes hyperemic. Labia
minora are hyper pigmented and
hypertrophied.
• · Vagina: Vaginal walls become hypertrophied
and more vascular. Increased blood supply
gives the bluish
• discolouration of the mucosa. The vaginal
secretions become copious, thin and white

22. Reproductive organs:
Uterus: There is enormous growth of the
uterus during pregnancy.
The uterus in non-pregnant state weighs
about 60 gm and measures about 7.5 x 5 x 2.5
cm in size.
 At term, it weighs 900-1000gm and measures
35 x 22 x 13 cm in size. 10mls to 5litres
The changes occur in all the parts of the
uterus that is the body, isthmus and cervix.

23. Reproductive organs:
• Body of the uterus: There is an increase in
growth and enlargement of the body of the
uterus.
• The muscle fibres undergo both hypertrophy
and hyperplasia [both increase in length and
breath and addition of new muscle fibres.]
• The uterus feels soft and elastic in contrast to
firm feel of the nongravid uterus.

24. Reproductive organs:
Decidua: Decidua is the name given to the
endometrium during pregnancy.
• It becomes thick and spongy and blood supply is
also increased.
• The upper and lower uterine segments are
formed towards the later weeks of pregnancy.
The shape of the uterus changes from pear
shaped to ovoid.
• Uterus rises out of the pelvic cavity by 12th week
of pregnancy.

25. Reproductive organs:
• Cervix: Cervix softens and loosens in
preparation for labour and delivery.
• There is hypertrophy and hyperplasia of the
elastic and connective tissues.
• Mucous production increases and forms a
thick plug (called operculum) effectively
sealing the cervical canal to prevent ascending
infection from the vaginal canals.

26. Reproductive organs:
• Ovary: Both the ovarian and uterine cycles of
the normal menstruation remains suspended.
Hence no ovulation takes place. Corpus
luteum persists in early pregnancy until the
development of placenta is completed.
• Fallopian tubes: They get enlarged as uterus
rises in pelvic and abdominal cavities.

27. Reproductive organs:
Breasts:
Marked hypertrophy and proliferation of ducts
and alveoli occurs that increase the size of the
breasts. Blood supply is increased.
The nipples become larger, erectile and deeply
pigmented.
The sebaceous glands become hypertrophied
and are called as “montgomery’s tubercles”
appear on the alveoli
Colostrum like fluid is expressed at the end of

28. • relaxation of the pelvic ligaments - relaxation
of the pelvic joints - the pelvis become more
mobile and increases in capacity

29. Changes in cardiovascular system.
• 1)- Peripheral vasodilatation occurs as early
as 6 weeks’ gestation
• (induced by progesterone- reduces
vascular smooth muscle tone) leading to a
decrease in systemic vascular resistance.
• (2)- Increased cardiac output (COP)- this is
achieved predominantly via an increase in
stroke volume and minimal increase in heart
rate (8 beats /minute).

30. • During pregnancy: COP increases by 20% at 8
weeks gestation
• upto 40-50% at 20-28 weeks gestation
(maximal pre-delivery COP).
• The plasma volume increases 40-50% and the
red blood cells(red bld cell mass) increases
only 20-25% that leads to haemodilution,
which causes physiological anemia in healthy
women at around 32weeks

31. • During labour further increases in COP by 15%
in the first stage
• 50%in the second stage due to the
combination of auto-transfusion of 300-500
ml of blood back into the circulation with each
uterine contraction

32. • -Immediate postpartum period: COP
increases again immediately after delivery due
to auto-transfusion of blood via uterine
contraction and relief of aortocaval
compression.
• This may increase COP by as much as 60-80%,

33. • Iron requirements increase (due to expanding
red cell mass and fetal requirements) from 2.5
mg/day in the first trimester to 6.6 mg/day in
the third trimester (700-1400 mg total
pregnancy).
• -Folate requirements increase in pregnancy
(due to the fetus, placenta, uterus and
expanded red cell mass).

34. Changes in the respiratory system:
• As the uterus grow, it presses on the
diaphragm and causes shallow and more
frequent respiration.
• Hence respiratory rate is slightly increased

35. • During pregnancy: oxygen consumption
increases by about 40%
• There is decrease in functional residual
capacity and residual volume of air as a
consequence of the elevated diaphragm due
to gravid uterus- hence shallow frequent
respirations
• In addition, airway conductance is increased
and total pulmonary resistance is reduced,
possibly as a result of progesterone.

36. • The result of all of these physiologic changes is
a hyperventilatory picture in the latter half of
pregnancy.
• This results in the picture of a chronic
respiratory alkalosis during pregnancy

37. Changes in digestive system:
Progesterone hormone causes the following
• relaxation of the cardiac sphincter- cause
increased reflux
• decreased gastric peristalsis which leads to
delayed gastric emptying – can cause
constipation
Nausea and vomiting occur in the morning
usually in early pregnancy.

38. • Heart burn and mild indigestion may occur.
• Increased salivation occurs-called as ptyalism.
• Cravings or desires to nonnutritive substances
may occur. After that condition is called as
pica.
• Bleeding gums and tooth loss due to
demineralization are common.
• Taste is often altered very early in pregnancy
• Increase appetite & thirst - frequent small

39. • Liver - Hepatic synthesis of albumin, plasma
globulin and fibrinogen increases
• Total hepatic synthesis of globulin increases
stimulated by estrogen
• gall bladder increases in size and empties
more slowly - relaxation of gall bladder
increases the tendency of gall stone formation
- cholestasis

40. Changes in the skin:
• There is hyperpigmentation due to increased
melanocyte stimulating hormone
• There is an increased pigmentation occurring
around the nipples and areola of the breasts,
• linea nigra -the center line of abdomen
• chloasma in the face especially on forehead
and cheek (the mask of pregnancy)
• striae gravidarum stretch of the abdominal
wall rupture of the subcutaneous elastic fibers
pink lines in flanks - become white after labor

41. Changes in skeletal system:
• Alternations in posture, walking and gait occur
due to change in center of gravity as the
uterus enlarges in size- Increased lumbar
lordosis
• Joint mobility is increased as a result of action
of relaxin (an ovarian hormone)
• Backache is common. Occasional calf muscle
cramps may occur due to calcium deficiency.

42. Changes in urinary system:
• There is also an increase in overall kidney size
by about 1-1.5 cm.
• A dilatation of the ureters and pelvis occurs
and is presumed to be secondary to the
smooth muscle–relaxing effect of
progesterone.
• This can lead to urinary stasis (vesico-ureteric
reflux) and an increased risk of developing
urinary tract infections (UTIs)

43. Changes in urinary system:
-Renal plasma flow increases by 50-70% in
pregnancy (in the first two trimesters) →
increased glomerular filtration rate (GFR),
reaching up to 150% of its normal level.
-The plasma creatinine,urea falls
• - The increased GFR increases filter load of
glucose, which may result in renal glycosuria.

44. Changes in urinary system:
• Frequency of urination is common in early
pregnancy as the gravid uterus pressing on the
bladder when it is in the pelvic cavity.
• Again frequency increases in the last few
weeks of pregnancy due to pressure from the
engaging fetal head.

45. Changes in endocrine system.
• The anterior pituitary gland is enlarged.
• Adrenocorticotrophic hormone
(ACTH)stimulate the adrenal glands to
produce corticol important for fetal lung
maturity, melanocyte stimulating hormone
and thyrotrophic hormone( fetal brain
development) increase their activities.

46. Weight gain in pregnancy:
• The total weight gain during pregnancy
averages 10 to 12 kg. The total weight gain is
distributed approximately as follows
• Distribution of weight gain during pregnancy
• Foetus 3.4 kg
• Placenta 0.6 kg
• Amniotic fluid 0.6 kg
• Fat deposit and protein 3.5 kg

47. FIRST TRIMESTER ADAPTATIONS
•Ambivalence- mixed feelings
•Introversion or narcissism
•Acceptance of pregnancy Need extra emotional
support from family members

48. AMBIVALENCE
• Most pregnancies are unintended and
unexpected
• Once the pregnancy is confirmed many
women have conflict feeling which is known as
ambivalence
• Pregnancy cause permanent life changes for
woman
• Primi mothers feel unsure of their ability to be
a good parent

49. Mood Swings
• Also known as emotional lability, this
psychological reaction can be caused by two
factors: hormonal changes or narcissism.
• Crying is a common manifestation of mood
swings, during and even after the pregnancy.

50. Grief
• Grief may arise from the realization that one’s
roles would be changed permanently.
• A pregnant woman would be weaned off her
role as a dependent daughter, or a friend who
is always available.
• Even the partner would have to leave the roles
or the life he has been accustomed to as a
man without a child to support.

51. INTROVERSION/NARCISSISM
• Many women become increasingly concerned
about heir ability to protect and provide for
the fetus.
• Undue preoccupation with oneself is
narcissism
• Concentration on the self(thoughts and
feelings) and body is introversion
•

52. • Some pregnant women also manifest
extroversion, or acting more active, healthier
and more outgoing than before their
pregnancy.
• Extroversion commonly happens to women
who had a hard time conceiving and finally hit
jackpot.

53. • Primi mothers wonder about the infant and
looks at baby pictures and eager to hear
stories what they were like as infants
• Multi paras know more about infants but they
are concerned with child's acceptance by
siblings

54. • Stress
• Pregnancy is a major change in roles that
could cause stress.
• The stress that a pregnant woman feels might
affect her ability to decide.
• The discomforts that she may feel could also
add up to the stress she is experiencing.
• Assess whether the woman is in an abusive
relationship as it may contribute further to the
stress.

55. ACCEPTANCE OF PREGNANCY
• A woman who cannot accept the pregnancy
will find it very difficult to accept the changes
necessitated by pregnancy, child birth and
interaction with the new born.

56. Changes in Sexual Desire
Women who are on the first trimester of
pregnancy experience a decrease in libido
mainly because of breast tenderness, nausea,
and fatigue.
• On the second trimester, sexual libido may rise
because of increased blood flow to the pelvic
area that supplies the placenta.
• The third trimester might bring an increase or
decrease in sexual libido due to an increase in
the abdominal size or difficulty in finding a

57. How to access pregnancy
acceptance-;
• Extent to which the pregnancy was planned
and wanted by the woman and her partner.
•Amount of time the woman in happy versus
depressed using the pregnancy
• •Amount of reported discomfort during
pregnancy and the woman's response to the
discomfort
• •Extent to which the woman accepts or
rejects in her body

58. SECOND TRIMESTER ADAPTATIONS
ROLE ASSUMPTION
•Assuming and adopting to the role of mother
are parts of a long term process.
•The psychological changes a woman
undergone during pregnancy that enable her
assume the maternal role actually build a life
long process of informal socialization of
learning a feminine identify

59. MATERNAL ROLE ATTAINMENT •
• that acquisition of the mothering role, is
described as process that begins prenatally
and ends with formation of a maternal
identify during the infants first years
• it is a process in which the mother achieves
competence in the role and integrates the
mothering behaviours in to her established
role set, so that she is comfortable with their
identify as a mother

60. SELF IMAGE AND BODY IMAGE
• self image will be affected especially in
unplanned pregnancy
• Body image during pregnancy has to do with
the woman’s perception of her size, how she
moves and her own physical beauty or
ugliness.

61. THIRD TRIMESTER ADAPTATIONS
LACK OF KNOWLEDGE AND PREPARATION FOR
MATERNAL ROLE
• In modern nuclear family, guidelines for
parenting are confusing and role models less
apparent than in some other family types
stressors include the lack of guidelines for
successful parenting. •

62. ESTABLISHING A RELATIONSHIP
WITH THE FETUS
• maternal roles = a mother needs to establish a
relationship with the infant to be.
•The relationship with fetus is thought to be
the first stage in establishing a relationship
with the new-born and then the child

63. DREAMS/FANTACIES DURING
PREGNANCY
• Experience strange dreams about childbirth,
new born baby, and life as a new mother.
• Baby's sex and nightmares .
• Fantasy is an important factor in assumption
of the maternal role and transition in to the
life style of women and child.
• Fantasies during pregnancy allow a women to
have a “dress rehearsal” for labor and delivery
and mothering of an infant.

64. CULTURAL ASPECTS IN PREGNANCY
• Food taboos are common, usually reflecting a
cultural belief that certain foods are unclean
or fears that ingesting certain food will
produce undesirable physical characteristic in
the new born.

65. ACTIVITY AND REST
• Must cultures encourage a pregnant women to
maintain normal activities, excluding
strenuous works, although some encourage
more rest during pregnancy.
• Norms for sexual activity during pregnancy
are more variable ranging form no change to
strict prohibition of sexual intercourse through
the second half of pregnancy
• Most cultures encourage rest in the
postpartum period, others 40 days no leaving

66. PREPARATION FOR BIRTH
• Some cultures view preparation in advance of
the event as potentially dangerous-