Pregnancy  Aches and Pains

o Caused by effect of hormones

 Usually lasts 40 weeks
giving extra fluids in joints
 Begins from first day of the woman’s
and tissues
last menstrual period and is divided
 Cramps
into three trimesters
o Possibly due to hormonal
Minor Conditions in Pregnancy changes
 Fainting
 Morning Sickness
o Not uncommon because
o Usually occurs in first 12
blood pressure tends to fall
weeks
 Varicose veins
o Some do not feel sick at all
o Pregnancy affect veins in that
 Heartburn
blood flow is slower than
o Burning sensation felt
usual
commonly in second half of
 Swelling (oedema)
pregnancy
o Due to slow blood flow,
o Occurs due to slight opening
blood may pool in the ankles,
of stomach which allows acid
etc.
to rise to esophagus
 Itching
 Constipation
o Common due to increased
o Due to smooth muscle
blood supply in skin
relaxant effect of
o Can be a sign of obstetric
progesterone
cholestasis
 Backache
 Stretchmarks
o Usually felt in lower back
 Changes in Skin Colour
o Occurs because the back does
not get the support it usually Physical Examination
gets
 Full general examination
 BP – most important vital sign. It
usually drops by the second trimester
  Pulse Rate – usually increases by 10 Examination of Pregnant Women
bts/min
 General inspection
 Respiratory Rate – increases in depth
 Vitals
but no significant change in rate
o Blood Pressure
 Shortness of breath and dyspnea is
 Chronic hypertension -
common
>140/>90 before 20 weeks
Anatomy and Physiology of gestation
 Gestational Hypertension -
 Hormonal changes
>140/>90 after 20 weeks
o Drives many of the
 Pre eclampsia - >140/>90
pregnancy changes
after 20 weeks with
 Cardiovascular changes
protein in urine
o Cardiac output increases
o Normal BMI is 19.9 – 26
 Muscoskeletal changes
o Measure fundal height –
o Weight gain
start from superior portion of
o Lumbar lordosis
pubic symphysis to the top of
 Breast changes fundus
o Enlarged moderately o Auscultate using fetoscope
o Become more nodular by the – 150-160s is normal for first
third month week and 120-140s by term
 Abdominal Palpation (Leopold’s
History taking in pregnant women
Maneuver)
 Ask about symptoms o Fundal Grip – while facing
 Assess maternal concerns and client palpate upper abdomen
attitudes about pregnancy with both hands
 Assess the current state of health o Umbilical Grip – palpate
 Assess past obstetrical history using one hand each side to
 Assess past medical history feel the back
 Assess family history of congenital o Pawlick’s Grip – while
diseases facing client’s feet palpate
 are above pubic symphysis to
assess whether the head has
descended
o Pelvic Grip – distinguishes
breech and
presentation
 Remember solving AOG and EDD
Initial Assessment of Newborn
 Identification – name,
registration number
 Gestational Age – full term, pre-
term, post-term
 APGAR scoring – normally 8-10
o Activity
o Pulse
o Grimace
o Appearance
o Respiration
 Vitals
o Respiration – 40 – 60 breaths
o Heart Rate – 120 – 140 beats
o Temperature – 36.5 – 37.5
Physical Examination
 Length – 47-50 cm
 Head Circumference – 33-35 cm
 Chest Circumference – 30-33 cm
 Weight – 2.5-3.5 kg
 Observe posture and movement
 Assess skin turgor
 Read the rest
Newborn Reflexes
vertex  Rooting reflex
o Disappears by 3-4 months
o Touching lower lip causes
infant to move head and open
mouth
sex,  Sucking reflex
o Disappears at 10 – 12 months
 Palmar grasp reflex
o Disappears at 3-4 months
o Touch ulnar side of hand
with finger
 Plantar grasp reflex
o Disappears at 8 – 10 months
o Touch the ball of newborn’s
foot. The toes should curl
downward
 Tonic neck reflex
o Disappears at 7 months
o Turn head to one side. Arm
and leg of turned side should
extend and opposite side
flexes
 Moro (Startle) reflex
o Disappears by 3 months
 o Response to sudden
stimulation or abrupt change
in position
 Babinski Reflex
o Disappears within 1 year
o Stroke ball of foot. It should
cause fanning of toes
 Stepping Reflex
o Disappears within 3-4
months
o Hold infant upright. One leg
should touch the surface
while the other is in walking
motion