Pregnancy Maternal and Child Nursing NUR 362 Lecture 3

The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ): TrimestersWeeks First trimester (early pregnancy)1-12 Second trimester (middle pregnancy)13-28 Third trimester (late pregnancy)29- 40

The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):

Regular visits during pregnancy Prenatal visits  Q 4 weeks for 1st 28 weeks  Q 2 weeks until 36 weeks, then  Q 1 week until childbirth

Important Estimates of Pregnancy These are tools used in calculating the gestational age of the growing fetus and its Expected Date of Birth (EDB) – Nagele’s Rule: Computation of expected date of birth. Formula: Last Menstrual Period in Day / Month / Year (+7) (-3) (+1) = Expected Date of Birth – Johnson’s Rule: estimates the weight of the fetus in grams.

The Diagnosis of the First Trimester 1. History and symptoms A. Cessation of menstruation This is the first frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.

1.The history and symptoms B. Nausea and vomiting Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10 th to 12 th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).

1.The history and symptoms C. Urinary symptoms Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.

2. Signs Breast changes Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas may be noted.

Changes of the reproductive organs Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested. Cervix: Cyanosis and a gradual softening due to congestion.

Changes of the reproductive organs Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12 th week, the fundus of the uterus is usually palpable above the symphysis pubis.

C. Supplementary examination Pregnancy test The laboratory test for pregnancy are based on the identification of human chorionic gonadotrophin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.

Basal body temperature (BBT) A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

Ultrasonography There are trans-vaginal and abdominal Ultrasonagraphys. A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period.

Ultrasonography Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week. Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

The diagnosis of the second and the third trimester pregnancy Symptoms Abdominal enlargement and fetal movement generally occurs after the 18 th to 20 th week of gestation.

Signs The uterus continues to enlarge Fetal movement (quickening) can usually be seen or heard after 18 th week of gestation

Height of the uterine top xiphoid

Signs Fetal heart sound can be heard at rate varies from 120 to 140 beats per minute. The fetal body can usually be palpated by the 18 th to 20 th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

Fetal heart

Other Examinations X-ray. It is rarely used recently because the harmfulness to the fetus. Fetal electrocardiogram. A fetal electrocardiogram can first be recorded at about the 12 th week of pregnancy.

Different methods of pregnancy diagnosis

Fetal lie & fetal Presentation Fetal lie: the relationship between the long axis of the mother and the long axis of the fetus. (longitudinal lie and transverse lie) Fetal presentation: the portion of the fetus that descends into pelvis first.