Pregnancy

Intercourse

Sperms travel to the ampulla of the fallopian tube

Capacitation – Upon sperm approach to the egg, the sperm releases hyaluronidase which dissolves the
protective layer of the egg allowing penetration of one sperm for normal fertilization

Fertilization – Joining of the sperm and the egg; Zygote – Product of fertilization

Zygote travels toward the uterus approx. 3 days. Meanwhile its cells are multiplying.
Zygote ( 1-8cells)
Morula ( 16-50 cells);
Blastocyst (when large cells begin to travel to the periphery, leaving a fluid-filled cell mass; in this form, the
fertilized egg will attach to the thick endometrial lining during the secretory phase); Trophoblasts: Cells on the
blastocyst’s outer ring that will develop into placenta and membranes; Embryoblasts: Inner cell mass that will
form the embryo

Implantation - Contact between the growing fertilized cell and the uterine lining
Apposition - Process by which the fertilized egg brushes the endometrial lining
Embryo – term used for the fertilized egg that has implanted.
Fetal Development

PREEMBRYONIC EMBRYONIC FETAL

Fertilization 2 Weeks 8 Weeks Birth

Decidu • Decidua Basalis – Layer that lies directly below the embryo the trophoblast to the maternal circulation
• Decidua Capsularis – Layer of the decidua that “encapsulates”/cover the trophoblast

a • Decidua Vera – remaining portion of the lining that fuses with the decidua capsularis

Chorionic • Structure to which the trophoblasts develop into

• Syncytiotrophpblasts – responsible for the production of placental hormones
Villi • Cytotrophoblasts/Langhan’s layer – serves to protect the fetus from infectious organisms for the first
trimester until the 20th – 24th week of pregnancy.

• Structure that is involves in mediating between maternal and fetal circulation and producing
essential hormone during pregnancy
• hCG – Human Chorionic Gonadotropin – first present for first 100 days
Placent • Estrogen – responsible for uterine growth and mammary gland development during pregnancy
• Progesterone – responsible for maintaining the endometrial lining of the uterus
a • hPL - Human Placental Lactogen – responsible in promoting mammary gland growth and
regulating maternal glucose, protein, and fat levels
Amniotic • Serves as cushion against pressure on the maternal abdomen which may injure the fetus
• Regulates temperature changes conducive for fetal survival

Fluid • Supports fetal muscular development by allowing spontaneous movements

• Serves as support to the umbilical cord against compression, which may compromise
delivery of oxygen and nutrients to the fetus

Amniotic • Provides support and produces the amniotic fluid

Membrane • Produces precursors to prostaglandin, which initiates contractions during labor

• No nerve supply, which is evident during the painless rupture of membranes

• Serves as pathway to transport oxygen and nutrients to and waste [products from the
fetal circulation to the maternal circulation
• Mostly composed of Wharton jelly, which acts as support for the blood vessels linking the

Umbilical fetal and maternal circulation

• In part, is also composed of smooth muscles which constrict upon fetal delivery, naturally

Cord clamping the blood vessels and preventing bleeding

• Consists of two arteries, which carry deoxygenated blood and one vein, which carry
oxygenated blood
• Smilar to amniotic membrane, has no nerve supply; hence, cord cutting is painless for
both the mother and child.
Diagnosis of Pregnancy
Presumptive Signs
Least indicative sign of
pregnancy; may be caused by
other conditions; subjective
 Breast engorgement and
uterine enlargement
 Flu-like symptoms: nausea,
vomiting, fever, fatigue
 Frequent urination
 Quickening
 Skin Changes: Linea nigra,
Chloasma, striae gravidarum
 Amenorrhea
Probable Signs Positive Signs
These signs are objective, these Confirmatory signs of pregnancy
are not always indicative of
pregnancy
 Laboratory test: Urine hCG,  (+)Fetal heart tone
Serum/Blood hCG ECG: 5 weeks AOG
 Chadwick’s sign Doppler: 10-12 weeks AOG
 Goodell’s sign Stethoscope: 18-20 weeks
 Hegar’s sign AOG
 Presence of gestation sac on  (+) Fetal movement by
utz examiner (20 – 24 weeks
 Ballottement AOG)
 Braxton-Hicks contraction  (+) Fetal outline upon
 Palpable Fetal Outline ultrasound
Maternal Changes
during Pregnancy
1. Psychological Task of Pregnancy
2. Physiologic Changes of Pregnancy
Psychological Tasks of Pregnancy
Trimester Description
1st: Accepting • Ambivalence is normal felt by both the pregnant woman and their
the pregnancy partner. Adjustments must be made to accommodate the coming
change in their lives, which may or may not be easily accepted
• The idea of having a child may be farfetched because the signs of
pregnancy are not as obvious as compared to the later trimesters.
2nd: Accepting • The child becomes distinct person and a part of the mother, especially
the baby when quickening is felt by the latter
• A measure of mother’s acceptance of her baby is how well she follows
prenatal instructions
• Health education is important for the father of the child to foster
acceptance of his role in the child’s life even at this stage
3rd: Preparing • Period of “nest-building” and childbirth classes
for parenthood
Physiologic Changes of Pregnancy
• Reproductive Changes
• Uterus: Enlargement due to stretching of fibers to accommodate
growing fetus
• Lightening: engagement of the fetal presenting part to the pelvis causing a derease
in fundal height
• Primigravid: 38 weeks
• Multigravid: during labor
• Hegar’s sign
• Ballotment
• Amenorrhea d/t elevated estrogen levels
• Goodell’s sign
• Operculum Formation
• Acidity of vaginal secretions
• Elevated Progesterone and estrogen levels
• Breast engorgement, fullness and tenderness
Physiologic Changes of Pregnancy
• Integumentary Changes
• Striae gravidarum
• Diastasis or separation of the rectus muscles in the abdominal wall as it stretches
during pregnancy, which appears as a bluish groove at separation site
• Linea Nigra
• Chloasma/ Melisma “mask of pregnancy”
• Umbilical Stretching
• Telangiectasis formation due to increased estrogen levels
• Palmar Erythema
• Increased scalp hair growth
Physiologic Changes of Pregnancy
• Respiratory Changes
• Nasal congestion
• SOB due to diaphragmatic compression of the enlarging uterus
• Decreased PaCO2 levels, facilitating diffusion of carbon dioxide from
fetal (higher concentration) to maternal (lower conc.) circulation
• Increased PaO2 for oxygen diffusion to the fetal circulation
• Resp. alkalosis (Increase blood pH and PaO2 levels, decrease PaCO2
level), compensated by HCO3 excretion in the urine by polyuria
Physiologic Changes of Pregnancy
• Cardiovascular Changes
• Inc blood volume, particularly plasma volume, inc cardiac output
• Pseudoanemia, d/t increase plasma volume
• Inc iron, folic acid demand
• Innocent heart murmurs with changes in the heart position
• Palpitations
• Slight decline in BP
• Inc peripheral blood flow, leading to vasocongestion
• Supine hypotension syndrome with supine positioning d/t venous
congestion with uterine compression of the inferior vena cava
• Inc clotting factors d/t increase estrogen levels
• Inc WBC for maternal protection and d/t increase plasma volume
• Dec total protein d/t fetal use; leads to edema on weight-bearing body parts
• Inc blood lipid content for fetal use
Physiologic Changes of Pregnancy
• Gastrointestinal Changes
• Nausea and vomiting that may be due to increase estrogen levels or
decrease glucose
• Heartburn, lower esophageal sphincter relaxation, and decrease
gastric motility associated with relaxin secretion
• Decreased bile emptying, leading to generalized pruritus (bile
salt accumulation) and gallstone formation
• Hemorrhoids d/t pressure on lower body veins
• Gingival tissue bleeding, hyperplasia
• Decrease salivary pH
Physiologic Changes of Pregnancy
• Temperature Changes
• Increase progesterone secretion by corpus luteum during 1st
trimester, causing increase maternal temperature
• Urinary Changes
• Sodium reabsorption
• Gradual urine output increase
• Decrease BUN, creatinine levels
• Skeletal Changes
• Relaxin and progesterone enforces their effects through the softening
of pelvic ligaments and joints, making it more mobile to facilitate
childbirth
• Lordosis
Physiologic Changes of Pregnancy
• Endocrine Changes
• Placenta serves as an endocrine organ through the secretion of the ff hormones:
• Estrogen, Progesterone, hCG, hPL (insulin antagonist, reducing its effectiveness during
pregnancy, leading to glucose levels elevated than normal to facilitate its diffusion to
fetal circulation)
• Ovaries secrete relaxin
• Prostaglandins are present in the female reproductive tract and may be the
initiator of urine contractions during labor
• Pituitary gland:
a) anterior: inc MSH, GH, prolactin; FSH, LH; b) Posterior: Inc oxytocin
• Inc BMR d/t inc thyroid hormone secretion; if iodine is insufficient,
goiter development because thyroid will compensate for inc work
• Inc corticosteroid (vs. fetal rejection) and aldosterone secretion (K sparing)
• Increase insulin production by pancreas but decrease effectiveness
• Decrease IgG production compensated by Increase WBC levels
Pregnancy Discomforts
• Breast tenderness • Abdominal Discomfort
• Palmar erythema • Leukorrhea
• Constipation • Nausea and vomiting
• Fatigue • Cravings
• Muscle Cramps • Heartburn or Pyrosis
• Hypotension • Backache
• Varicosities • Headache
• Hemorrhoids • Dyspnea
• Heart Palpitations • Ankle Edema
• Frequent Urination • Braxton-Hicks Contraction
Nutrition in Pregnancy
• Normal weight gain: 25 – 35lbs (11.5 – 16kg)
• 1st trimester: 2 to 4 pounds or 1 – 2 kilograms per trimester
• 2nd and 3rd trimester: 1lb (0.5kg/week)
• Caloric Intake
• Women of child-bearing age: 2200 cal
• Pregnant women: 2500 cal
Prenatal Exercises
Prenatal Yoga Squatting
Kegel’s Abdominal muscle
Exercises Tailor- contraction Pelvic Rocking
Sitting
OB SCORING – GP TPALM
GravidaParity TermPretermAbortionLivingMultiplepregnancies
Fetal Development
Step by Step
A. Germinal Stage (1 – 10 days)
1. Fertilization – ampulla
Ovum – 12 to 24
hours
Spermatozoon – up to 5
days Zygote
Cell Division or Mitosis
Step by Step
2. Implantation – other term Nidation
- 3 to 4 days travel to the uterus
Zygote → Blastocyst →
Embryo
Trophoblast – outer layer of a blastocyst
- excretes proteolytic enzymes
- buries itself to the uterine lining
Step by Step
B. Embryonic Stage (10 days to 8 weeks)
The endometrium is now called the decidua, and the
area directly under the trophoblast is called the decidua
basalis. The trophoblastic cells begin to form the chorion or
outermost sac and sends thousands of projections called the
villi which invade the decidua and lay the groundwork for
the placenta.
Step by Step
B. Embryonic Stage (10 days to 8 weeks)
Cytotrophoblastic cells in the chorion produce human
chorionic gonadotropin hormone (hCG) and is excreted in
the urine. Two cavities will appear in the ball of cells. A new
layer of cells called the mesoderm (middle skin) has grown
over the original lining. The more central cavity, the yolk sac
will ultimately disappear since it serves no useful purpose in
humans. The amniotic cavity will soon enclose the embryo.
Step by Step
B. Embryonic Stage (10 days to 8 weeks)
Embryonic Disc. Three layers of cells lying between the yolk sac
and amniotic cavity form the embryonic disc from which the entire
body will ultimately be formed.
Ectoderm (outermost layer of amniotic cavity) will become
the skin, nervous system, and sense organs.
Mesoderm (middle layer) primarily will become the
musculoskeletal, circulatory and genitourinary
systems.
Endoderm or entoderm (innermost layer) will become the
respiratory and gastrointestinal tracts as well as
urinary bladder and part of other body system.
Step by Step
B. Embryonic Stage (10 days to 8 weeks)
Amniotic Sac also known as the bag of water, protects the
fetus in the womb.
Chorionic membranes is the outermost fetal
membrane, the villous part which becomes the
fetal part of the placenta.
Amniotic membranes is the innermost fetal membrane
that holds the amniotic fluid and the fetus.
Amniotic Fluid is a clear, slightly yellowish liquid
that surrounds the fetus.
Step by Step
B. Embryonic Stage (10 days to 8 weeks)
Umbilical Cord also known as the navel string, birth cord, or
funiculus umbilicalis, is a conduit between the developing
embryo and the placenta.
AVA – 2 arteries, 1 vein
Wharton’s jelly is the jelatinous substance which
helps prevent kinking.
The Zygote—Month 1
• Fertilized egg reaches the uterus and attaches itself
to the uterus.
• Cell multiplication begins
• Internal organs and circulatory system begins to form.
• Cell Division takes place and at the end of two
weeks the zygote is the size of a pin-head
• Heart begins to beat
• Small bumps show the beginnings of arms and legs
Parts of the Zygote
4 Weeks
The Embryo—Month 2
• At 5 weeks the embryo is ¼ inch long
• All major organ systems develop
• The placenta and Umbilical Cord develop
• Placenta- The tissue that connects the sac around
the unborn baby to the mother’s uterus
• Umbilical Cord- Tube that connects the baby to
the placenta
• Brings the baby nourishment and oxygen from the mother’s blood
• Takes away waster products
• Amniotic Fluid surrounds the baby
• Face, and limbs take shape
Two Months
6 Weeks 7 Weeks 8 Weeks
7 weeks 8 weeks
The Fetus—Month 3
• The fetus is about 1 inch long
• Nostrils, mouth, lips, teeth buds, and eyelids form
• Fingers and toes are almost complete
• Eyelids are fused shut
• Arms, legs, fingers, and toes have developed
• All internal organs are present—but aren’t ready to function
• The genital organs can be recognized as male or female
3 Months
 12 Weeks

11 Weeks
The Fetus—Month 4
• Fetus is 3 inches long and weights 5 oz.
• Your baby is covered with a layer of thick, downy hair called
lanugo.
• His heartbeat can be heard clearly.
• This may be when you feel your baby's first kick.
• The baby can such thumb, swallow and hiccup.
4 months
15 Weeks 18 Weeks

16 Weeks
The Fetus—Month 5
• The Fetus is about 6 inches long and weighs 4-5 oz.
• A protective coating called vernix begins to form on baby's skin.
• Hair eyelashes and eyebrows appear
• Organs keep maturing
• Fetus is very active
• The eyes can open and blink
 Smallest baby in the world
born At just 22 weeks

• She was 10 OUNCES when born and 9.5 inches.

That's just longer than the length of your hand. She
weighed less than a can of soda!
The Fetus—Month 6
• The fetus is 8-10 inches long and weighs 4-5 oz.
• Your baby's lungs are filled with amniotic fluid, and he
has started breathing motions.
• If you talk or sing, he can hear you.
• Fat is starting to deposit under the skin
6 Months
The Fetus—Month 7
• Fetus is 10-12 inches long and weighs about 1-2 pounds.
• Fetus is active and then rests.
• The baby now uses the four senses of vision, hearing,
taste and touch
Seven Months
The Fetus—Month 8
• The fetus is 14-16 inches long and weighs 2-3 pounds
• Layers of fat are piling on.
• Fetus has probably turned head-down in preparation for birth.
• Fetus may react to noises with a jerking action
Eight Month
The Fetus—Month 9
• Fetus is about 17-18 inches long and weighs 5-6 pounds
• Skin is smooth because of the fat
• Baby’s movement slows down due to lack of room
• “Lightening” occurs when the baby drops in the pelvis
• Disease fighting antibodies are taken from the mother’s blood
Fetal Circulation
Major Differences
1. Exchange of O2 and CO2 takes place in the placenta, not in
the fetal lungs.
2. Because little blood goes to the fetal lungs, pressure in the left
side of the fetal heart is less than pressure on the right.
3. Presence of accessory structures.
Accessory Structures
• Foramen Ovale- bypasses the pulmonary circulatory
system since it is the opening between the right and the
left atria.
• Ductus arteriosus-communication between the
pulmonary artery and the aorta
• Ductus venosus- communication which bypasses the liver
• Umbilical vein- carries the most highly oxygenated blood
• Umbilical arteries-carry deoxygenated blood.
Fetal Growth Estimation
McDonald’s rule: the use of symphysis-fundal height measurement to estimate fetal AOG through landmarks in maternal abdom
For every cm = +1 week AOG
Level of symphysis pubis = 12 weeks AOG
Level of Umbilicus = 20 weeks
Level of xiphoid process = 36 weeks
Fetal Well-being
• Fetal Movement
• At least 10 times a day
• Sandovsky method: with the mother in left recumbent position after a meal, fetal
movements are measured for an hour. Usually, the fetus will move twice every 10
minutes, and the test may be extended to another hour if the number of fetal
movements are less than the normal.
• Cardiff method: The time it takes for 10 fetal movements to occur is counted. It is
important to know if the child is on active time for the accuracy of the test.
Fetal Well-being
• Fetal Heart Rate
• Normal: 120 – 160bpm
• Rhythm Strip Testing: With the mother in semi-fowler’s position, an
external fetal heart monitor is attached to her abdomen to check FHT for
20 mins
• Non-stress Test: This measures the response of FHR to fetal
movement. Reactive if two accelerations of FHR lasting for 15 seconds
occur after movement.
• Vibroacoustic stimulation: An acoustic stimulator is used to produce a
sharp sound expected to wake a sleeping fetus, eliciting FHR changes
• Contraction Stress Test: With nipple stimulation, the FHR is assessed in
relation to uterine contractions. Contractions are stimulated thrice within
10 minutes, lasting 40 seconds or longer.
Fetal Well-being
• Ultrasonography
• Best results are achieved when the mother has full-bladder during the test.
• Place a towel under the mother’s right buttock to avoid supine hypotension
syndrome during the test
• Maternal Serum Alpha-fetoprotein
• If abnormally high, fetus has open spinal or abdominal effect
• If low, fetus has chromosomal anomaly
• Amnioscopy
• Performed to assess for meconium staining
• Fetoscopy
• Used to perform fetus-related procedures
Fetal Well-being
• Amniocentesis
• Aspiration of amniotic fluid for testing at 14-16th week AOG
• Instruct the mother to void prior to testing
• Place towel under the mother’s right buttocks to avoid supine
hypotension syndrome during the test.
Components analyzed:
a) Alpha-Fetoprotein
b) Bilirubin (blood compatibility)
c) Fetal Fibronectin (to determine preterm labor)
d) Lecithin/sphingomyelin ration (to determine lung maturity)
Fetal Well-being
• Percutaneous Umbilical Cord Sampling
• Aspiration of fetal blood via the umbilical vein for analysis
• Kleihauer-Betke Test: used to determine of sample if fetal or maternal blood
• Biophysical Profile
• Assessment procedure combining 5 parameters to determine fetal well-being
• Includes: 1) fetal reactivity 2) fetal breathing movements 3) fetal
body movements 4) fetal tone 5) amniotic fluid volume
• Each parameter is given as its highest score, and cumulatively the
highest score is 10.
• More accurate vs. other tests
Labor and Delivery
Intrapartum Care
• Refers to the medical and nursing care given to the pregnant
woman during labor and delivery.

• Personal Data
• Baseline Data
• Obstetrical Data
• Physical Exam
• Pelvic Exams
Theories of Onset of Labor
1. Uterine Stretch Theory
2. Prostaglandin Theory
3. Progesterone Theory
4. Theory of Aging Placenta
5. Oxytocin Stimulation Theory
Preliminary Signs of Labor
1. Lightening/fetal descent
2. Corresponding manifestations: Ease of breathing, shooting leg
pains, urinary frequency, increased volume of vaginal
discharge
3. Increased activity levels (r/t increased epinephrine levels
in preparation for birth)
4. Slight weight loss (associated with urinary frequency)
5. Braxton-Hicks Contraction
6. Cervical Ripening ( with butter-soft texture)
The 5P’s of Labor
1. Passenger 2. Power
a. Fetal Head
a. Primary Power
b. Bones
c. Suture Lines b. Secondary Power
d. Fontanels``
a. Sagittal – connects 2
parietal bones
b. Coronal – connects parietal
and frontal
c. Lambdoidal – connects
parietal and occipital bones
The 5P’s of Labor
3. Passageway
• Route the fetus travels during childbirth
• The fetal head must pass through the narrowest diameters of the pelvic
inlet (anteroposterior diameter) and pelvic outlet (transverse diameter)
4. Position of the Parturient
• First stage of labor: Left Lateral Recumbent
• Second Stage: Lithotomy Position, McRoberts's Position
5. Psyche
• Women’s psychological outlook regarding pregnancy and child birth
True Labor vs False Labor
Sign True Labor False Labor
Contraction (surest sign) Regular and predictable Irregular and unpredictable
Directionality Starts from lower back Felt abdominally only
sweeping around the
abdomen
Relief None; continuous Relieved by rest
Duration, frequency, intensity Increasing Not increasing
Cervical dilatation Present Absent
Bloody Show Present Absent
Rupture of Membranes Present Absent
* Remember that the amniotic fluid is produced by the amniotic membrane, and its
production does not stop until placental delivery; hence, there is no dry labor. Amniotic
Fluid can be differentiated from urine using fern test or Nitrazine paper test
FOURTH STAGE OF LABOR

First 1-2 hours after delivery which is said

to be the most critical stage for the mother
because of unstable
FOURTH STAGE OF LABOR
Assessment:
Fundus: Should be checked 15-30 mins for the next 4
hours. Should be firm and a little above the umbilicus
during the first 12 hours post-partum
Lochia: Should be moderate in amount and immediately
after delivery, a perineal pad can be completely
saturated after 30
Bladder: A full bladder is evidenced by the fundus which
is to the right of the midline, dark red bleeding
some clots.
Perineum: normally tender, discolored and edematous. It
should be clean with intact sutures
BP and PR: maybe slightly increased from excitement and
effort of delivery, but normalize within one hour.
FOURTH STAGE OF LABOR
Rooming-in Concept
• Mother and baby are together while
they are in the hospital to developing
bonding.
• Encourage
• Encourage Kangaroo Mother Care
  Phases
 Talking-in
 Taking-hold
 Letting-go

Psychologic  Development of parental love

al Changes and positive family relationships
 Rooming-in
 Sibling visitation
Psychological Changes

 Maternal concerns and feelings

 Abandonme
 Disappointment
 Postpartal
Physiologic Changes

 Reproductive changes
 Uterus
Cervix
 Lochi
 Vagina
 Perineum
Physiologic Changes

 Hormonal
 Urinary
 Circulatory
Integumentary
 Gastrointestin
Physiologic ChangesEffects of retrogressive changes
 Exhaustion
 Weight loss

 Vital signs
 Temperatur
 Pulse
 Blood pressure
 Progressive changes
 Lactation
 Return of menstrual flow
Nursing Care: First 24 Hours
Postpartum
 Assessment
 Health history
Pregnancy
 Family profile
 Labor and birth history
 Infant
 Postpartal course
Nursing Care: First 24 Hours data
 Laboratory
Postpartum  Physical assessment
 General appearance
Face
 Ha
 Eyes

 Progressive changes
 Lactatio
 Return of menstrual flow
Thank you!