Pregnancy

1. First trimester
The first trimester is the most crucial to the baby's development. During this period, the baby's
body structure and organ systems develop. Most miscarriages and birth defects occur during this
period.
The body also undergoes major changes during the first trimester. These changes often cause a
variety of symptoms, including nausea, fatigue, breast tenderness and frequent urination.
Although these are common pregnancy symptoms, every woman has a different experience. For
example, while some may experience an increased energy level during this period, others may
feel very tired and emotional.

2. Second Trimester
The second trimester of pregnancy is often called the "golden period" because many of the
unpleasant effects of early pregnancy disappear. During the second trimester, you're likely to
experience decreased nausea, better sleep patterns and an increased energy level. However, you
may experience a whole new set of symptoms, such as back pain, abdominal pain, leg cramps,
constipation and heartburn.
Somewhere between 16 weeks and 20 weeks, you may feel the baby's first fluttering movements

3. Third Trimester
The mother may feel more uncomfortable now as she continues to gain weight and begins to
have false labor contractions (called Braxton-Hicks contractions).
During the third trimester of pregnancy, fetus development continues to grow in size and weight.
The lungs are still maturing and the fetus begins to position itself head-down. By the end of the
third trimester, the fetus is about 19 to 21 inches long and weighs, on average, six to nine
pounds.

 Fetal development during the third trimester includes:

 The fetus can see and hear.
 The brain continues to develop.
 The kidneys and lungs continue to mature.
 By the 36th week, the head may "engage" (drop into the pelvic area) - a process
called "lightening."
 The bones of the skull remain soft to make it easier to pass through the birth canal.
 For many babies, the irises of the eyes are slate blue. The permanent eye color will
not appear until several days or weeks after birth.
 The fetus can suck its thumb and has the ability to cry.
 By 38 to 40 weeks, the fetus' lanugo has disappeared almost completely.
 By 38 to 40 weeks, the lungs have matured completely.
 The baby is covered in vernix caseosa (or simply called vernix), a creamy, protective
coating on the skin.
 The head will usually turn downward during the last couple of weeks of pregnancy.
 Changes in the mother's body
In the third trimester of pregnancy, some women become increasingly uncomfortable as their due
date nears. As the fetus grows in size and crowds the abdominal cavity, some mothers-to-be have
difficulty taking deep breaths or getting comfortable at night for sleep, while others are free from
any discomfort as they anxiously await the arrival of their new son or daughter.

 List of changes and symptoms experiencd during the third trimester and includes:

 Increased skin temperature as fetus radiates body heat, causing the mother to feel hot.
 Increased urinary frequency returns due to increased pressure placed on bladder.
 Blood pressure may decrease as the fetus presses on the main vein that returns blood
to the heart.
 Swelling of the ankles, hands and face may occur (called edema), as the mother
continues to retain fluids.
 Hair may begin to grow on a woman's arms, legs, and face due to increased hormone
stimulation of hair follicles. Hair may also feel coarser.
 Leg cramps may become more frequent.
 Braxton-Hicks contractions (false labor) may begin to occur at irregular intervals in
preparation for childbirth.
 Stretch marks may appear on the abdomen, breast, thighs and buttocks.
 Colostrum (a fluid in the breasts that nourishes the baby until the breast milk becomes
available) may begin to leak from the nipples.
 Dry, itchy skin may persist, particularly on the abdomen, as the skin continues to
grow and stretch.
 A woman's libido (sexual drive) may decrease.
 Skin pigmentation may become more apparent, especially dark patches of skin on the
face.
 Constipation, heartburn and indigestion may continue.
 Increased white-colored vaginal discharge (leukorrhea) which may contain more
mucus.
 Backaches may persist and increase in intensity.
 Hemorrhoids may persist and increase in severity.
 Varicose veins in the legs may persist and increase.

Signs of Pregnancy
1. Presumptive Signs of Pregnancy (Subjective)
 Least indicative of pregnancy
 Taken as single entities, could easily indicate other conditions.
 Experienced by the woman but cannot be documented by an examiner.

2. Probable Signs of Pregnancy

 Objective and can be documented by an examiner.
 More reliable than presumptive signs, they still are not positive or true diagnostic
findings.
 Laboratory Tests
  Commonly used: based on detecting the presence of human chorionic
gonadotropin (hCG).
 hCG - a hormone created by the chorionic villi of the placenta, in the
urine or blood serum of the pregnant woman
 All laboratory tests for pregnancy are accurate in diagnosing pregnancy only
95% to 98% of the time, positive results from these tests are considered probable
rather than positive signs.

 Home Pregnancy Tests

 Most based on immunologic reactions are available over the counter.
 Have high degree of accuracy (about 97%) if the instructions are followed
exactly.

3. Positive Signs of Pregnancy

 Demonstration of a fetal heart separate from the mother’s

- Fetal heart has been beating since the 24th day after conception.
- Fetal heart rate usually ranges between 120 and 160 beats per minute

 Fetal heart beat

 Detected on Echocardiography as early as 5 weeks.
 Detected on ultrasound as early as 6th to 7th week of pregnancy.
 Detected by auscultation of the abdomen with an ordinary stethoscope
at about 18 to 20 weeks.

 Fetal heart sounds

- Difficult to hear if a woman’s abdomen has a great deal of subcutaneous fat or
if a larger than normal amount of amniotic fluid is present (hydramnios).
- Heard best when the position of the fetus is determined by palpation and the
stethoscope is placed over the area of the fetus’s back.


Detected through Doppler Technique early as the 10th to 12th week of
gestation.
 Fetal movements felt by an examiner
- May be felt by a woman as early as 16 to 20 weeks of pregnancy.
- Those felt by an objective examiner are considered much more reliable.
(movement can be mistaken by mother as movement of gas)
 Can be felt by an examiner at the 20th to 24th week unless extremely obese.

 Visualization of the fetus by ultrasound

 A characteristic ring, indicating the gestational sac, will be revealed on an
oscilloscope screen as early as the fourth to sixth week of pregnancy
  By the eighth week, a fetal outline can be seen so clearly within the sac that the
crown-to-rump length can be measured to establish the gestational age of the
pregnancy
- Also gives information about the site of implantation and whether a multiple
pregnancy exists.

4. Danger Signs of Pregnancy

a) Vaginal Bleeding
 Serious bleeding complications of pregnancy begin with only slight spotting.
 If discovered on toilet paper following a bowel movement, she is probably reporting
spotting from hemorrhoids.
 Until the bleeding is found to be innocent all women with spotting need further
evaluation.

b) Persistent Vomiting
- depletes the nutritional supply available to a fetus so is a danger to the
pregnancy.
 Vomiting more than once or twice a day.
 Vomiting that continues past the 12th week of pregnancy is also extended vomiting.

c) Chills and Fever

 May indicate an intrauterine infection (serious complication for woman and fetus)
 A woman cannot make a definite determination about the cause of a fever, further
evaluation by a health care provider is necessary.

d) Sudden Escape of Clear Fluid From the Vagina

 Means the membranes have ruptured and mother and fetus are now both
threatened, because the uterine cavity is no longer sealed against infection.
- If a fetus is small so the head does not fit snugly into the cervix, the umbilical
cord may prolapse following membrane rupture.
- If the cord is then compressed by the fetal head, oxygenation is compromised
and a fetus will be in immediate and grave danger.
 Alerting a health care provider to any sudden escape of fluid is crucial so a safe
and controlled birth can be planned.
 Occasionally, a woman confuses stress incontinence (involuntary loss of urine on
coughing or sneezing or lifting a heavy object) for this.
- In this situation, vaginal examination typically reveals that the membranes are
still intact.
e) Abdominal or Chest Pain
 Report it immediately.
 Health teaching: A pregnant uterus normally expands painlessly.
 Possible complications implicated by abdominal pain:
- Tubal (ectopic) pregnancy
- Separation of the placenta
- Preterm labor
- Appendicitis
- Ulcer
- Pancreatitis.
 Chest pain may indicate a pulmonary embolus
- A complication that can follow thrombophlebitis.

f) Pregnancy-Induced Hypertension (PIH)

 Refers to a potentially severe and even fatal elevation of blood pressure that
occurs during pregnancy.
 Must not have occurred prior to pregnancy.
 Several symptoms signal that PIH is developing:
- Rapid weight gain (over 2 lb per week in the second trimester, 1 lb per week in
the third trimester)
- Swelling of the face or fingers
- Flashes of light or dots before the eyes
- Dimness or blurring of vision
- Severe, continuous headache
- Decreased urine output

 Some edema of the ankles during pregnancy is normal (if it occurs after a woman
has been on her feet for a long period)
 Edema indicated by swelling of the hands or face
 cerebral edema or acute hypertension – signalled by visual disturbances or a
continuous headache

g) Increase or Decrease in Fetal Movement

 An unusual increase or decrease in movement compared to the fetus’ usual may
suggest that a fetus is responding to a need for oxygen.
- Ask a woman about typical fetal movements and any increase or decrease in
this rate. If there has been a change, she is a candidate for further testing and
follow-up.