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•menarche (beginning) - average age onset is 11-13 years and average
range is 9-17 years are not unusual
•interval (between cycles) - average is 28 days; cycles of 23-35 days •duration (of menstrual flow) - average flow is 2-7 days; ranges 1-9
days are not abnormal
•amount (of menstrual flow) - difficult to estimate; average of 30- 80
ml per menstrual period; saturating a pad or tampon in less than an hour is heavy bleeding. endometrial cells
•color (of menstrual flow) - dark red; combination of blood, mucus and •odor - similar to that of marigolds
PHASES OF THE MENSTRUAL CYCLE 1. Proloferative •endometrium begins to proliferate •growth is very rapid;increases the thickness to approximately eightfoldm •increase continues for the 1st half of the menstrual cycle •also termed as "estrogenic", "follicular"; "postmenstrual phase" 2. Secretory •increase in estrogen receptor content •formation of progesterone in the corpus luteum of the ovary gland causes it to become twisted in appearance and dilated with quantities of glycogen and mucin •other terms: Progestational, Luteal, Premenstrual or Secretory Phase 3. Ischemic •if (-)fertilization , the corpus luteum in the ovary begins to regress after 8-10 days •progesterone and estrogen production regresses •withdrawal of progesterone stimulation causes the endometrium to degenerate 4. Menses
Contraction and Braxton Hicks . fragments of endometrial tissue and microscopic.softening of the cervix •Souffle. 16 weeks by fetoscope.•capillaries rupture.bluis discoloration of the vaginal wall •Hegars .10 weeks by doppler. with minute hemorrhages •endometrium sloughs off •discharges from the uterus: blood (from ruptured capillaries).painless contraction at 28 weeks 3.felt by the examiner usually after 20 weeks .presence of gonadotropin in urine •Ballotment . Presumptive (changes felt by the woman) •Morning Sickness •Amenorrhea •Changes in the Breast •Fatigue •Lassitude •Urinary Frequency •Quickening (18th-20th weeks) 2.softening of the Lower Uterine Segment •Uterine Enlargement .at 12 weeks gestation felt just above the symphysis pubis •Positive Pregnancy Test . 18-20 weks by auscultation •Fetal movement . Probable (changes observed by the examiner) •Chadwicks . athrophied and unfertilized ovum PREGNANCY Signs and Symptoms 1. Positive (definitive signs) •Fetal Heart Beat . mucin (from glands).sinking and rebound of the fetus •Outlining of the fetal Body •Goodells .
Term . after 24 weeks of gestation.has an average length for approximately 280 days or 40 weeks in either direction Placenta . specifically the Decidua basalis .is palpable above the level of the symphysis pubis between 12-14 weeks.occurs at the upper 2/3 of the uterus within a week after fertilization Pregnancy .cowper gland releases fluids with continuous enlargement and thickening of the penis in men.climactic expulsive contraction of the entire urethra with ejaculation in men and orgasmic flatform or contraction of the outer third of vagina in women Resolution . midway between the umbilicus and symphysis pubis at 16 weeks at the level of umbilicus or 20 cm above symphysis pubis at the 20th week.by sonogram OB BULLETS Sexual response follows distinct phases as follows: phases of excitement .a woman has never been pregnant Parity . Nulligravida .a significant indicator of fetal well-being.age of gestation of 38 to the end of 42 weeks of pregnancy FHR .rapid erection of penis in men and clitoral enlrgement and vaginal lubrication in women plateau .•Fetal Skeleton . regardless of number of fetuses and whether the fetus was born alive or dead. and fetal chorionic layer (embryonic parts) Fundus .a woman who has completed one pregnancy with a fetus that reached the age of viability. then rises 1cm per week until 36 weeks.is form by the endometrium (maternal uterine walls). while full elevation of uterus with concurrent rising of cervix in females orgasm .the number of past pregnancies that has reached period of viability (possibility of survival outside the uterus. which is the most common . It is heard below the mother's umbilicus LOA (left occiput Anterior). Primipara . at least 20 cms in length or atleast 600g in weight).is the union of the ovum and spermatozoon within 24 hours after ovulation occuring in the outer third of the fallofian tube (ampulla) Implantation .the return of pre-arousal states in both sexes Fertilization .
(>160bpm) is an early sign of fetal hypoxia and fetal Bradycardia (<110 bpm) is alate sign of fetal hypoxia REPORT frequency (of uterine contraction) of less than every two minutes. Mgt: induction of labor. and softening of the uterus with closed cervix and (+) BOW. or abruptio placenta Lochia results from endometrial sloughing. Mgt: may give Oxytocin Missed Abortion . Abortion .unpreventable cervical dilation with persistent hemorrhage and sever cramping. the fundus is 1 cm or fingerbreadth above the umbilicus.any pregnancy that terminates before age of viability Threatened Abortio . and monitor for s/sx of infection and DIC Habitual Abortion .yellow to white. treatment: Cerclage (encircling cervix with suture). fetal distress. It then descends by one fingerbreadth each succeeding day until it returns as a pelvic organ on the 10th day. WOF bleeding Inevitable abortion .Pink to brownish with fleshy smell.with history of three or more abortions. or ROA (right occiput anterior) another common position. RhoGAM is given to Rh. during 1-3 days after delivery Serosa . management: CBR. Mgt: D/C. after 20 weeks gestation. commonly due to incompetent cervix.expulsion of some part of conception. 4-9 days Alba . using Shirodkar or Mcdonald technique Fetal Tachycardia . Report Fetal Movement of the three or less in a one hour period.negative mothers within 72 hours after birth of Rh positive baby to prevent development of antibodies in the maternal . Mgt: save and count pads. Abstinence.expuksion of all parts of conception.It is red with fresh odor and some clots. oxytocin. Rubra . and duration of more than 90 seconds as it may lead to uterine rupture.Bleeding. IV or blood transfusion Complete Abortion . cramping. (-) BOW.fetus dies in the utero and has not been expelled and cervix maybe closed. The presence of Alpha Fetoprotein in the amniotic fluid indicates Nural Tube Defect. Emotional support Incomplete abortion .position. on the 10th day Within 12 hrs after birth. monitor Hemorrhage.
faster in primigravida and breast feeding mothers.5-6 because of the production of lactic acid (doderlein bacillus) Breast . into the pelvis. cervical plug formed by clot of thick mucus Ovaries . connective tissue lossens and small muscle cells hypertrophy. edema. pH is 3. most marked in the fundus. which is used for the management of urinary incontinence post partum.pigmentary changes occur because of melanocytestimulating hormone elevated from the 2nd month of pregnancy Metabolic system . which will be fatal to succeeding Rh positive offsprings (Erythroblastosis fetalis) Post Partum Blues . Involution . hypertrophy and hyperplasia of cervical glands -. larger nipples.tender and tingle in the early weeks of pregnancy. increasedin size.reddish.ovulation ceasesthroughout pregnancy Vagina . Cervix .increased vascularity.is common from 3-7 days after delivery Kegel's Exercise . at the level of the umbilicusby the 20th weeks AOG. vaginal secretions increase. vaginal mucosa increase in thickness. chadwick's sign is noted.pronounced softening and cyanosis (due to increased vascularity. xiphoid by the 36th descends slightly during the last 3 weeks due to fetal descend.Goodell's sign ).bloodstream. breasts and thighs Linea Nigra .is the alternate tightening and relaxing of the pubococcygeal muscles."Mask of Pregnancy" are brownish patches of pigment on the face Pigmentation .enlargement and thickening of the uterus. CHANGES DURING PREGNANCY Reproductive system uterus .line of dark pigment extending from the umbilicus down the midline to the symphysis Chloasma . hyperemia. slightly depressed streaks in the abdominal wall.return to non pregnant state. more pigmented Integumentary system Striae Gravidarum .and softening of the perineum and vulva.
Oxytocin Cardiovascular changes Heart .average woman retains 6.cardiac volume increases by 40-50% Respiratory system Urinary System . Circulation . There may be splitting of the first heart sound with common systolic murmurs. iron is transferred to fetus and stored in fetal liver. amniotic fluid (900 gm).fats are more completely absorbed during pregnancy. Human placental Lactogen Pituitary .elevated estrogen and progesterone. 3rd trimester = 8-12 lbs Water Metabolism .5 liters of extra water during pregnancy Protein Metabolism .produces Estrogen. uterus and maternal blood are rich in protein Carbohydrate metabolism . suppressed LH. plasma lipid levels increases during the second half of pregnancy Iron Metabolism . Blood volume(1800 gm). Endocrine system Placenta . Pregnancy potentially can initiate diabetes and DM may be aggravated by pregnancy. FSH. Breast Tissue(1400 gm).iron requirement increases to 20-40 mg daily. Progesterone. maternal stores(1800-3600 gm) 1st trimester = 2-4lbs. During pregnancy there is sparing of glucose used by maternal tissues and a shunting of glucose to the placenta for use by the fetus Fat Metabolism .Weight Gain . progesterone and insulin produced by the placenta during pregnancy oppose the action of insulin during pregnancy. 2nd trimester = 12-14 lbs. HCG. placenta(450 gm).average weight gain is 11-13kgs (24-28 lbs).Human placental lactopgen.fetus. during the last half of pregnancy.is displaced upward by elevated diaphragm. uterus(1 gm). fetus(3400 gm). estrogen.
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