4. PREGNANCY
Definition
The period from conception to birth. After the egg is fertilized
by a sperm and then implanted in the lining of the uterus, it
develops into the placenta and embryo, and later into a fetus.
Pregnancy usually lasts 40 weeks, beginning from the first day
of the woman's last menstrual period, and is divided into three
trimesters, each lasting three months.
Description
Pregnancy is a state in which a woman carries a fertilized egg
inside her body.
5. MINOR AILMENTS DURING PREGNANCY
There are certain minor ailments which may affect
in pregnancy – because you are pregnant! They
are not serious, but you would probably love to
know how to get rid of them!They may occur due
to hormonal,metabolic and postural
changes.Unfortunately, there are not magical cures
for many of these ailments, until pregnancy is
further advanced or over; but most of them can be
helped if we take a few simple steps.
6.
7. MORNING SICKNESS
This usually occurs during the first 12
weeks of pregnancy and can be
aggravated. Some women feel sicker
in the evenings and some do not feel
sick at all.
8. HOW TO EASE MORNING SICKNESS:
Get up slowly after having a warm drink and a dry biscuit
or a piece of toast.
Eat small meals at frequent intervals and avoid fatty, spicy
foods.
Drink plenty and don’t go hungry but take meals and fluids
slowly. Take drinks between meals rather than with food
and make sure you have enough fluid.
Avoid cooking food with strong smells.
If woman is being excessively sick or if sickness goes on after
you are 14-16 weeks pregnant, she must contact her Doctor.
9. HEARTBURN
Heartburn is a condition in which there is a “burning” sensation
and tends to occur in the second half of pregnancy. It can be felt
across the lower part of the chest, in the throat or back of the
mouth or in the stomach. This occurs because the valve at the
top of the stomach opens up slightly and acid, which the
stomach usually uses for digestion, rises into the gullet
(oesophagus) giving a burning feeling. If women are prone to
heartburn, it
will be worse after big meals, particularly if they are highly
spiced or fatty, and after bending over or when lying flat.
10. HOW TO REDUCE HEARTBURN:-
Eat small, frequent light meals.
Drink a glass of milk.
Avoid a totally empty stomach.
Avoid fatty or spicy foods.
Bend at your knees rather than at your waist to pick things up.
Use an extra pillow at night.
11. CONSTIPATION
Woman may become constipated at any
stage of pregnancy, making going to the
toilet (opening your bowels and passing
stools) more difficult and uncomfortable.
This is due to smooth muscle relaxant
effect of progesterone causing decreased
peristalsis of the gut.
12. HOW TO PREVENT CONSTIPATION:
Include plenty of fiber in diet (whole meal breads,
wholegrain cereals, fruit and vegetables, and pulses such as
beans and lentils).
Exercise regularly to keep the muscles toned.
Drink plenty of water.
Avoid iron pills if they give constipation.
13.
14. BACKACHE
The relaxed muscles, ligaments and joints in
the body may mean that the back is not
getting the support it usually gets. The
discomfort is usually felt in the lower part of
the back or between the hip bones and tends
to worsen as pregnancy progresses. If it gets
very severe and spreads down to legs or if it
starts to get “tingling”, report this to Doctor.
15. HOW TO TREAT THIS:
Stand tall, with the top of the head pushed up towards the ceiling.
Practice standing up straight, with spine as straight as possible.
Make sure that lower back is supported when sitting.
If bed is very soft or if the mattress sags, put a board under it to help keep
your back straighter.
If you are getting very tired from the aching, sit down to do some of your
household jobs or work and have some extra rest.
Attend Relaxation or Preparation for Childbirth classes where you will be
taught how to lie in such a way that the pressure of baby’s weight is off your
back.
16. ACHES & PAINS
These can be in wrists, hands, feet, legs, a
stitch in side or just a general aching all
over. These ache and pains are probably
due to the effect of the hormones which
might cause slightly extra fluid in tissues
and loosen joints. Body too does not get
its usual support, as your muscles are
more relaxed because of the hormones.
17. WHAT TO DO:-
Use any exercise that have been taught
at Relaxation classes to help with
particular aches.
Inform your Doctor as soon as possible
of severe or continuing pain.
18. CRAMPS
Cramps in the legs or feet are
not uncommon. The cause is
not known but is probably due
to chemical and hormonal
changes in the body.
19. HOW TO TREAT CRAMPS:
Make gentle leg movements in a warm
bath prior to settling for the night.
Sleep with the footend of the bed elevated
by 20-25cm.
Take vitamin b complex and calcium
supplements.
20.
21. FAINTING
Fainting is not unusual during the
early weeks of pregnancy
because the blood pressure tends
to fall at that time due to
vasodialation under the influence
of progesterone.
22. TO AVOID THIS:-
Wear cooler, loose clothes.
Don’t stand for too long.
Beware of hot, enclosed areas.
IF YOU FEEL FAINT:-
Try to find somewhere to sit down.
Loosen tight clothes.
Put your head down.
Get into fresh air as soon as possible.
23. VARICOSE VEINS
Slight varicose veins and some swelling
and aching of the legs are not
uncommon. Pregnancy affects the veins
in that the blood flow from the legs is
more sluggish than usual. Standing for
long periods or sitting with legs down or
crossed often makes the problem worse.
24. HOW TO IMPROVE THE SITUATION:-
-Avoid standing in one place for a long time.
- Always sit with your feet up. Your legs
should be well supported and slightly higher
than the seat on which you are sitting.
-Take some walking exercise.
- Use support tights. Put them on before you
get up in the morning or after sitting with your
feet higher than your hips for at least 15
minutes.
25. SWELLING (OEDEMA)
Oedema, or swelling, is a common problem which affects
the vast majority of pregnant women. Circulation is
slowed down due to the extra blood required to supply the
growing fetus (baby). Because of this the blood can pool,
causing swelling in the ankles, feet and hands. Oedema is
often worse in hot weather, or when standing for long
periods of time. The midwife will ask at your antenatal
appointments if you have oedema. Although it is normal,
along with other symptoms it can sometimes be associated
with pre-eclampsia, which needs special treatment.
26. HOW TO RESOLVE SWELLING:
• Try to keep your feet elevated. It often helps to put pillows
under your feet when you are in bed.
• Likewise, you could try putting your bed on a subtle tilt
• Gentle but firm massage up the leg can help to relieve
discomfort
• Support tights can help – and your midwife can provide these
• Drink plenty, as keeping well hydrated helps your body to
retain less water
• Take regular light exercise to help increase circulation
• Avoid high-heeled shoes
• Eat a varied diet and avoid salty foods.
27.
28. ITCHING
Mild itching is common in pregnancy because of the
increased blood supply to the skin. In late pregnancy the
skin of the abdomen is stretched and this may also cause
itchiness. Wearing loose clothing may help. Itching can,
however, be a sign of a more serious problem called
obstetric cholestasis.
If itching becomes severe, or you develop jaundice
(yellowing of the whites of the eyes and skin), see your
doctor. Itching that’s associated with a rash may also
need treatment if it is severe.
29. STRETCH MARKS
During pregnancy your skin stretches as your baby
grows and for most women this causes stretch marks.
To start with, they appear as red lines, usually on
your tummy, hips and thighs. After your baby is born
they will tend to fade and become silvery in colour.
There are many creams and lotions available that
claim to prevent and reduce the appearance of stretch
marks, but it’s not known whether any particular
ingredients bring special benefits.
30. CHANGES IN SKIN COLOUR
Often there is alteration in the colour of skin, with
patches which become darker than usual. When
this affects the face it is called the “mask of
pregnancy” or “chloasma” because the marking
almost looks like a theatrical face mask. It is due to
the hormones and gradually disappears after the
baby is born. Nipples too become darker, and there
is a brown vertical line on the abdomen.
31.
32. INSOMNIA
Insomnia is difficulty in sleeping and
can be caused by several things:-
- Size and shape, especially towards
the end of pregnancy.
- Backache
- Worry
33. TO BE MORE COMFORTABLE:-
- Change your position – another pillow
under your head and shoulders or lie on
your side.
- Read/relax and have a warm drink.
- Talk to Doctor.
- Never take sleeping pills without
consulting the Doctor.
34.
35. VAGINAL DISCHARGE
The usual white, slightly thickened fluid discharge
from the vagina is nearly always increased in
pregnancy because the glands in the neck of the
womb (cervix) are more active than usual and
produce extra mucus. A change in colour or an
unpleasant smell with accompanying itchiness or
irritation is almost certain due to vaginal infection
and your Doctor should be consulted.
36. IT CAN BE TREATED BY:-
- Washing between your legs at least twice a day with
plenty of clean water and a little mild soap or none at all
(If using flannels, keep them very clean.)
- Not douching inside the vagina.
- Drying yourself well.
- Wearing clean, cotton pants every day.
- Not using talc or feminine applications.
- Informing your Doctor if you develop any itchiness,
irritation or soreness or if you notice thick, yellow
unpleasant smelling discharge.
37. . BLEEDING GUMS
Pregnancy hormones make your gums much
more likely to bleed. It’s important that you
keep your teeth and gums healthy – make sure
you clean your teeth twice a day and use
dental floss and mouthwash if you need to.
NHS dental care is free during pregnancy and
for one year after, so you should make an
appointment to see your dentist.
38. ANTENATAL CARE
Antenatal care refers to care
given to an expectant
mother from the time of
conception until the
beginning of labour.
39. ANTENATAL VISITS
Antenatal mother should visit the antenatal
clinic once a month in the first seven
months,twice a month during eighth
month,and there after once a week if every
thing is normal.
First visit at 20 weeks or as soon as the
pregnancy is known.second visit at 32nd week
and third visit at 36th week.
40. THE INITIAL EXAMINATION
The first visit irrespective of
when it occurs,should include
client’s health history,obstetric
history,physical
examination,pelvic examination
and investigations.
42. Identifying information
Chief complaints in her own words.medical conditions that
affect the pregnancy may vary from common UTI’s to severe
cardiac conditions.some of the medical conditions that require
special attention are:
1.Urinary tract infections
2.Essential hypertension that may lead to pregnancy induced
hypertension
3.Asthma,epilepsy,psychiatric disorders.
4.Medical conditions such as diabetes and cardiac conditions
43. (a) Family history
1.History of conditions that are genetic in
origin,familial or have racial chracterstics
such as:
2.Diabetes
3.Hypertension
4.Multiple pregnanacies
5.Spina bifida,sickle cell anemia,thalassemia
47. PHYSICAL EXAMINATION
The physical examination is performed for all women
during the pre-conceptional visit or the first pregnancy
visit. The elements of the physical examination include:
general appearance and nutrition; blood pressure, pulse,
height to weight profile, present weight; head and neck,
heart and lungs, breasts, abdomen, pelvic area
tenderness, extremities and back, neuromuscular; and
pelvic evaluation - speculum and bimanual examination,
clinic pelvimetry.
48. The physical examination must be carried out
in an organized manner.
THE COMPONENTS ARE
Physical measurements:
1.Temperature
2.Pulse
3.Respiration
4.Blood pressure
49. General observation
1.Appropriateness of appearance
2.State of health
3.Mental and emotional state
4.Posture ,gait ,and body movements
5.Findings such as fainting,cyanosis,respiratory
distress.
6.Evaluation of health ,dietary pattern,and ability
to carry daily activities.
50. GENERAL PHYSICAL
EXAMINATION (HEAD TO TOE)
1.HAIR AND SCALP:
Evaluate for general character,scalp
infections,lice,dandruff,alopecia and lumps.
2.HEAD:
Headache,dizziness,fainting,sinusitis,involuntary
movements.
51. 3.EYES:
Assess for burring of vision,blind spots of
the vision,diplopia,photophobia,
Lacrimation
discharge,redness,burning,glasses and
contact lenses,injuries,infection
Colour of conjunctiva,pupillary size and
reaction to light. `
56. 9.ABDOMEN:
1.Size of uterus,contour of abdominal
wall,any scar or injury marks,linea nigra and
striae gravidarum.
2.Determination of
lie,presentation,position,variety of fetus.
3.Measurement of fundal height,abdominal
girth,palpation of fetal position and
auscultation of fetal heart tones.
57. LOCATION OF FUNDAL HEIGHT AT VARIOUS WEEKS OF GESTATION
WEEKS OF GESTATION
EXPECTED LOCATION OF FUNDAL HEIGHT
12 WEEKS At level of symphysis pubis
16 WEEKS Half way between symphysis pubis and umblicus
20 WEEKS 1-2 Fingerbreadths beow the umblicus
22-24 WEEKS Level of umblicus
28-30 WEEKS 1/3rd of the way between umbilicus and xiphoid process(3 fingerbreadth above
umbilicus)
32 WEEKS 2/3rd of the way between umbilicus and xiphoid process(3-4 fingerbreadth below
xiphoid process)
36 WEEKS Level of xiphoid process
40 WEEKS 2-3 fingerbreadth below xiphoid process if lightening occurs
58.
59. ABDOMINAL PALPATION
The term palpation is used to mean doing Leopold’s manoeuvers for
determining ftal lie,presentation,position and engagement.
The following information is obtained from abdominal palpation:
1.Evaluation of uterine irritability,tone,tenderness,consistency and the
contractility present.
2.Evaluation of uterine muscle tone.
3.Detection of fundal movement.estimation of fetal weight.
4.Determination of fetal lie,presentation,position and variety.
5.Determination of whether the head is engaged or not.
60. In obstetrics, Leopold's Maneuvers
are a common and systematic way to
determine the position of a fetus
inside the woman's uterus; they are
named after the gynecologist
Christian Gerhard Leopold. They are
also used to estimate term fetal
weight.
61. Performing the maneuvers
Leopold's Maneuvers are difficult to perform on obese women
and women who have polyhydramnios. The palpation can
sometimes be uncomfortable for the woman if care is not taken
to ensure she is relaxed and adequately positioned. To aid in
this, the health care provider should first ensure that the woman
has recently emptied her bladder. If she has not, she may need
to have a straight urinary catheter inserted to empty it if she is
unable to micturate herself. The woman should lie on her back
with her shoulders raised slightly on a pillow and her knees
drawn up a little. Her abdomen should be uncovered, and most
women appreciate it if the individual performing the maneuver
warms their hands prior to palpation.
62. First maneuver: Fundal Grip
While facing the woman, palpate the woman's
upper abdomen with both hands. A professional
can often determine the size, consistency, shape,
and mobility of the form that is felt. The fetal head
is hard, firm, round, and moves independently of
the trunk while the buttocks feel softer, are
symmetric, and the shoulders and limbs have small
bony processes; unlike the head, they move with
the trunk.
63. Second maneuver: Umbilical Grip
After the upper abdomen has been palpated and the form that is found is
identified, the individual performing the maneuver attempts to determine
the location of the fetal back. Still facing the woman, the health care
provider palpates the abdomen with gentle but also deep pressure using
the palm of the hands. First the right hand remains steady on one side of
the abdomen while the left hand explores the right side of the woman's
uterus. This is then repeated using the opposite side and hands. The fetal
back will feel firm and smooth while fetal extremities (arms, legs, etc.)
should feel like small irregularities and protrusions. The fetal back, once
determined, should connect with the form found in the upper abdomen
and also a mass in the maternal inlet, lower abdomen.
64. Third maneuver: Pawlick's Grip
In the third maneuver the health care provider attempts to determine what
fetal part is lying above the inlet, or lower abdomen. The individual
performing the maneuver first grasps the lower portion of the abdomen
just above the pubic symphysis with the thumb and fingers of the right
hand. This maneuver should yield the opposite information and validate
the findings of the first maneuver. If the woman enters labor, this is the
part which will most likely come first in a vaginal birth. If it is the head
and is not actively engaged in the birthing process, it may be gently
pushed back and forth. The Pawlick's Grip, although still used by some
obstetricians, is not recommended as it is more uncomfortable for the
woman. Instead, a two-handed approach is favored by placing the fingers
of both hands laterally on either side of the presenting part.
65. Fourth maneuver: Pelvic Grip
The last maneuver requires that the health care provider
face the woman's feet, as he or she will attempt to locate
the fetus' brow. The fingers of both hands are moved
gently down the sides of the uterus toward the pubis.
The side where there is resistance to the descent of the
fingers toward the pubis is greatest is where the brow is
located. If the head of the fetus is well-flexed, it should
be on the opposite side from the fetal back. If the fetal
head is extended though, the occiput is instead felt and
is located on the same side as the back.
66.
67. OTHER FINDINGS:
LIE: It is relationship of long axis of fetus to long axis of
the uterus.there are 3 possible
lies;longitudinal,transeverse,oblique.
PRESENTATION: It refers to the part of fetus which lies
at the pelvic brim or in the lower pole of uterus.there are
three possible positions;cephalic,breech,shoulder.
ATTITUDE: It is the relationship of the fetal head and
limbs to its trunk.
68. DENOMINATOR: It is the name of the part
of the presentation that is used when referring
to fetal position.each presentation has
different denominator which are as follows:
1.Occiput in vertex presentation.
2.Sacrum in breech presentation
3.Mentum in face presentation
4.Acromian process in shoulder presentation
69. POSITION: It is the relationship between
denominator and six points on pelvic brim.
ENGAGEMENT: When the widest presenting
transverse diameter of fetal part has passed
through the brim of pelvis.
10. LEGS:Status of joints,muscles,leg
varicosities,appearance of nails and fingers.
11.FEET:Skin colour,odema,appearance of nails
and toes.
70. INVESTIGATIONS:
HEIGHT: Height over 160 cm is indication of normal pelvis.
WEIGHT: Weight is checked on every visit and the rate of
gain to be assessed.There is about 12-14 kg weight gain
throughout the pregnancy.
BLOOD PRESSURE: It is checked to provide a baseline
reading for comparasion throughout pregnancy.An adequate
blood pressure is required to maintain placental perfusion.a
blood pressure of 140/90mmHg at the first visit is indicative of
hypertension.
72. BLOOD TESTS:
1.ABO Blood group and Rh factor
2.Hemoglobin and hematocrit.
3.Veneral disease research laboratory test(VDRL)
4.Human immunodeficiency virus(HIV)
5.Rubella immune status
6.Hb estimation:normal value should be 12-
14gm/dl
