CARE OF MOTHER AND ADOLESCENT

(Well Client RLE Skills Lab)

Female Reproductive System – is one of the most vital parts of the human
reproductive process.

 Although a man is needed to reproduce, it is the woman who incubates the developing
fetus and delivers the child into the world.
 Potential Ova – produces egg cells or sex cells ; women are born with a large number of
it.
 It is usually around age 12 that these cells are mature enough to sustain life.
 Menopause – commonly begins between the ages 45 and 55.

MAJOR ORGANS OF THE FEMALE REPRODUCTIVE SYSTEM:

 Vagina – a muscular tube that receives the penis during intercourse and through it, a
baby leaves the uterus during child birth.
 Uterus – an organ that holds and nourishes a developing fetus, if an egg was properly
fertilized.
 Ovaries – the female gonads that produces ova. When one matures, it is released down
into a fallopian tube.
 Fallopian Tubes – small tubes that transport ova from the ovaries to the uterus. This is
where an egg waits to be fertilized.

- When properly fertilized by a man’s sperm (either through sexual intercourse or artificial
insemination), the woman’s egg carries all the necessary material to produce children.
- While pregnant, a woman will go through several internal signs before the typical “baby belly”
begins to show. These signs are the body’s reactions to the hormones generated during the
fertilization process.
- As a fetus grows, a woman’s body will prepare for the birthing process, which includes the widening of
the pubic symphysis, a joint between the two pubic bones.

- Vaginal birth - is the most common form of delivery.

- The use of cesarean section (removing the child through a surgical incision in the mother’s abdomen) is
on the rise.
  Vaginal Artery – supplies blood to the mucous mebrane of the vagina ; this artery is only
found in females.
-it is said to come from either the uterine artery or the internal iliac
artery. In males, the inferior vesical artery may be assumed to be the same as the vaginal artery in
females.

- it also branches into the fundus (upper part of the vagina), vestibule (contains
the vaginal opening), and parts of the rectum.

 There are frequently two to three branches of the vaginal artery that are present in women. This
varies per individual.

 Vaginal Artery Plexus (or Vaginal Venous Artery) – are two arteries found in either side
of the vagina which is drained by the vaginal veins and empty into the hypogastric
veins.
-communicates with the vesicle,
hemorrhoidal plexuses, and the uterine plexuses ; it extends midway into a midline vaginal artery in
the posterior and anterior walls of the vagina.

- is part of the cardiovascular system,

and passes through the floor of the pelvis, draining into the internal iliac vein.

 Vaginal Artery Flow - naturally moves laterally, starting from the cardinal ligaments (also
called the lateral cerval ligament) and passing through the paravaginal suspensory ligaments on
the way to the vagina.

 4 PLEXUSES IN CHARGE FOR EMPTYING THE PELVIC ORGANS:

- Vesicle Venous Plexus
- Uterine Venous Plexus
- Rectal Venous Plexus
- Vaginal Venous Plexus (or Vaginal Artery Plexus)

 5 MAIN FUNCTIONS OF FEMALE REPRODUCTIVE SYSTEM:

- Producing gametes called eggs
- Secreting sex hormones (such as estrogen)
- Providing a site for fertilization
- Gestating a fetus if fertilization occurs
- Giving birth to a baby, and breastfeeding a baby after birtt
*the only thing missing is sperm*
  LMP: Abbreviation for "Last Menstrual Period"
 By convention, pregnancies are dated in weeks starting from the first day of a woman's last
menstrual period (LMP).
 If her menstrual periods are regular and ovulation occurs on day 14 of her cycle, conception
takes place about 2 weeks after her LMP.

 How does LMP work in Pregnancy?

- Pregnancy lasts an average of 280 days (40 weeks) from the first day of your last menstrual
period (LMP).
- The first day of your LMP is considered day one of pregnancy, even though you probably
didn't conceive until about two weeks later (fetal development lags two weeks behind your
pregnancy dates).

 What is the Importance of LMP?

- Accurate recalling of LMP is crucial for maternal health as it helps to calculate the
gestational age accurately.
 Which is more accurate LMP or Ultrasound?
- Ultrasound was more accurate than LMP in dating, and when it was used the number of
post term pregnancies (kapag lumampas na sa normal gestational age) decreased.

- Crown-rump length (ultrasound measurement Crown- ulo ng bata ; Rump - pwet ng bata)
of 15-60 mm was superior to BPD, but then BPD (at least 21 mm) was more precise.
Combining more than one ultrasonic measurements did not improve dating accuracy.

*BPD – Biparietal Diameter (maximum diameter of a developing baby’s skill at the level
of the parietal eminences).

 When are your most Fertile Days?

- You're most fertile at the time of ovulation (when an egg is released from your ovaries),
which usually occurs 12 to 14 days before your next period starts. This is the time of the
month when you're most likely to get pregnant. It's unlikely that you'll get pregnant just
after your period, although it can happen.

 How many Ultrasounds do you have during your pregnancy?

- Most healthy women receive two ultrasound scans during pregnancy. "The first is, ideally,
in the first trimester (simula sa huli mong period hanggang week 12) to confirm the due
date, and the second is at 18-22 weeks to confirm normal anatomy and the sex of the baby.

 Can too many ultrasounds harm your baby?

- Having multiple ultrasound examinations during pregnancy is unlikely to cause any lasting
harm to the developing fetus, according to a new study that confirms the long-term safety
of the commonly used procedure ( sabi daw eh edi ok)
 Franz Naegele (1778– 1851) – a German Obstetrician who attributed the theory that a
pregnancy is 40 weeks or 280 days in duration. His rule adds nine months and seven days to the
first day of the last menstrual period.

 What is Naegele’s Formula?

- For example: Your last menstrual period began on September 9, 2010. Counting back 3
calendar months would be June 9, 2010. Adding 1 year and 7 days would bring you to June
16, 2011, as your estimated due date. This 3-step method is referred to as Naegele's Rule
and is based on a normal 28-day menstrual cycle.

 How does Naegele's rule work?

- Naegele's rule, derived from a German obstetrician, subtracts 3 months and adds 7 days to
calculate the estimated due date (EDD). It is prudent for the obstetrician to get a detailed
menstrual history, including duration, flow, previous menstrual periods, and hormonal
contraceptives.

 How do you calculate gestational age from Naegele's rule?

- Estimated date of a term delivery (also known as estimated date of confinement [EDC]) is
calculated by adding one year and seven days to the LMP and then subtracting three
months. This calculation is known as Naegele's rule and assumes that ovulation occurs two
weeks after the LMP.
*Pero take note: yung method daw na ito is less accurate kapag napaaga o ma-late ang
ovulation sa cycle, and for women with irregular menstrual periods.

 What is LMP in Naegele's rule?

- The due date or expected date of confinement (EDC) can be calculated using Naegele's Rule.
Begin on the first day of the last menstrual period (LMP), subtract 3 months, add 7 days,
and then add 1 year.

 What is McDonalds rule in pregnancy?

- That distance, measured in centimeters, is approximately equal to the weeks of gestation,
from about mid-pregnancy until nearly the end of pregnancy.

 How is Mcdonalds AOG (Age Of Gestation) calculated?

- We may use the McDonald's rule for fundal height by week: At 12 weeks, the uterus' fundus
is located just above the pubic bone.
 - We may also use the formula: GA = 6.5858 - 2.7073 * √SFH + (1.2952 * SFH)
 ESTIMATING GESTATIONAL AGE
- If everyone had normal, regular periods, every 28 days, and could remember exactly when
their last period was, and ovulation always occurred on day #14 of the menstrual cycle, then
gestational age determination would be easy. These assumptions, however, are not always
the case. In real life, determining gestational age can be challenging.

- The estimated delivery date is calculated by adding 280 days to the first day of the last
menstrual period. An alternative method of determining the due date is to add 7 days to
the LMP, subtract three months, and add one year. These calculations are made easier with
the use of a pregnancy wheel or ?? (naputol)

- One way to approximate a pregnancy's current gestational age is to use a tape measure to
determine the distance from the pubic bone up over the top of the uterus to the very top.
That distance, measured in centimeters, is approximately equal to the weeks of gestation,
from about mid-pregnancy until nearly the end of pregnancy. This is known as MacDonald's
Rule. If a tape measure is unavailable, these rough guidelines can be used:

1. At 12 weeks, the uterus is just barely palpable above the pubic bone, using only an
abdominal hand.
2. At 16 weeks, the top of the uterus is 1/2 way between the pubic bone and the
umbilicus.
3. At 20-22 weeks, the top of the uterus is right at the umbilicus.
4. At full term, the top of the uterus is at the level of the ribs (xiphoid process). This is
known as MacDonald's Rule

 Ultrasound can be used to determine gestational age. Measurement of a crownrump length

during the first trimester (1-13 weeks) will give a gestational age that is usually accurate to
within 3 days of the actual due date. During the second trimester (14-28 weeks), measurement
of the biparietal diameter will accurately predict the due date within 10-14 days in most cases.
In the third trimester, the accuracy of ultrasound in predicting the due date is less, with a plus or
minus confidence range of as much as 3 weeks. A chart showing different ultrasound
measurements at differe rtablnt gestational ages in shown in the table:
 A good preparation for the upcoming labor and delivery prevents life threatening risks to the
mother and the baby. To have an idea when the estimated date of delivery (EDD) is, the nurse
should have knowledge on the different estimates used for pregnant women. These techniques
may or may not exactly point out the EDD or age of gestation, but it tries to estimate the age of
pregnancy and possible date of delivery for the mother to be prepared.
 Nagele’s Rule
 Nagele’s rule is used to determine the EDD on the basis of the first day of the last menstrual
period or LMP. To calculate the date of birth in this rule, subtract 3 months from the first day of
LMP then add 7 days and change the year. For example the last menstrual period (LMP) began
July 30, 2010. To determine the EDD follow the following steps:
1.) Subtract 3 months (June 30, May 30, April 30) = April 30, 2010

2.) Add 7 days then change the year = April 30 + 7 (April has 30 days only, thus,
adding 7 days would make the EDD May 7) = May 7 (change the year) = May 7,
2011

• Modified McDonald’s Rule

- McDonald’s Rule or method is used to determine the age of gestation by measuring

from the fundus (obtaining the fundal height) to the symphysis pubis. The distance
in centimeters will determine the age of gestation from 16-38 weeks. (From Benson
and Pernoll’s handbook of obstetrics and gynecology)

 Johnson’s Rule

- Johnson’s rule is used to estimate the weight of the fetus in grams. To determine this, a
standard formula is used.

- Formula: fundic height in cm – n x k

- k is constant, it is always 155

- n is 12 if the fetus is engaged. It is 11 if the fetus is not yet engaged.

 Example: A fundic height of 28 cm, and the fetus is not engaged.

28 cm – 11 x 155 = 17 x 155 = 2635 grams

• Bartholomew’s Rule of Fourths - this method estimates the age of gestation relative to the
height of the fundus of the uterus above the symphysis pubis.

• By 3rd lunar month (12 weeks), the fundus is slightly palpated above the symphysis pubis.

• By the 5th lunar month (20 weeks), the fundus is palpable at the level of the umbilicus.

• On the 9th lunar month, the fundus is at the level of the xiphoid process

*Xiphoid Process - the most distal edge of the sternum or the breastbone.*

*Pubic Symphysis - a joint sandwiched between your left pelvic bone and your right pelvic
bone
 Leopold Maneuvers

- used to palpate the gravid uterus (a pregnant uterus entrapped in the pelvic cavity)
systematically.

- this method of abdominal palpation is of low cost, easy to perform, and non-invasive. It
is used to determine the position, presentation, and engagement of the fetus in utero
(in the uterus).

- The maneuvers consist of four distinct actions, each helping to determine the position
of the fetus:

a.) First maneuver: fundal grip

b.) Second maneuver: lateral grip.

c.) Third maneuver: second pelvic grip or Pawlik's grip.

d.) Fourth maneuver: Leopold's first pelvic grip

 Why are the Leopold maneuvers important to nurses?

- The abdominal examination method of Leopold's Maneuvers is a way to determine the

position of a fetus inside the uterus by touching the abdomen by hands. This method is
expected to enable expectant mothers to perceive the fetal position, and stimulate the
awareness of child presence.
Steps Purpose Procedure Findings

First Maneuver: To determine fetal Using both hands, Head is more firm,
Fundal Grip part lying in the feel for the fetal hard and round that
fundus.To part lying in the moves
determine fundus. independently of the
presentation body.

Breech is less well

defined that moves
only in conjunction
with the body.

Second Maneuver: To identify location One hand is used to Fetal back is

Umbilical Grip of fetal back. To steady the uterus on smooth, hard, and
determine position. one side of the resistant
abdomen while the surface Knees and
other hand moves elbows of fetus feel
slightly on a circular with a number of
motion from top to angular nodulation
the lower segment
of the uterus to feel
for the fetal back
and small fetal
parts. Use gentle
but deep pressure.

Third Maneuver: To determine Using thumb and The presenting part

Pawlik’s Grip engagement of finger, grasp the is notengaged if it is
presenting part. lower portion of the not movable.It is not
abdomen above yet engaged if it is
symphisis pubis, still movable.
press in slightly and
make gentle
movements from
side to side.

Fourth Maneuver: To determine the Facing foot part of Good attitude – if

Pelvic Grip degree of flexion of the woman, palpate brow correspond to
fetal head.To fetal head pressing the side (2nd
determine attitude downward about 2 maneuver) that
or habitus. inches above the contained the
inguinal ligament. elbows and knees.
Use both hands.
 Poor atitude – if
examining fingers
will meet an
obstruction on the
same side as fetal
back
(hyperextended
head)Also palpates
infant’s
anteroposterior
position. If brow is
very easily palpated,
fetus is at posterior
position (occiput
pointing towards
woman’s back)

 Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can
be already palpated.

Preparation:
1.) Instruct woman to empty her bladder first.

2.) Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal
muscles. Place a small pillow under the head for comfort.

3.) Drape properly to maintain privacy.

4.) Explain procedure to the patient.

5.) Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).

6.) Use the palm for palpation not the fingers.

 

 How do you examine the Cervix?

- Pap Test - doctor uses a vaginal speculum to hold the vaginal walls apart and to see the
cervix. Next, a sample of cells from your cervix is collected using a small cone-shaped brush and
a tiny plastic spatula (1 and 2).

 What is done during an internal exam?

- A physical exam of the vulva, vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. First,
the vulva is checked for redness, swelling, sores, or other abnormalities. A speculum is then
inserted into the vagina to widen it so the vagina and cervix can be checked for signs of
disease.

 Preparation for an Internal Exam

- Two days before Pap test, advice client to avoid sexual intercourse , vaginal creams,
suppositories, medicine and douches, as these may obscure abnormal cells. Client must also
take care of their body to feel comfortable during their first exam.
 What are the 3 Parts of the Cervical Examination when assessing for labor progress?
1.) how dilated the cervix is
2.) how low the baby is
3.) how much the cervix has shortened

 How do you describe a normal cervix?

- Normal : Cervical os is small and round in nulliparous and slit like after child birth. The cervix is
covered by smooth pink epithelium.

Cervix:
Speculum Exam of To evaluate the cervix and vaginal wall.
Method Of Exam
 Speculum Technique:
1.) To prepare for an adequate examination, the patient should be given an opportunity to
empty her bladder and should be draped appropriately

2.) The examiner should use warm gloved hands and a warm speculum.

3.) Each step of the examination should be explained in advance to the patient

4.) Always do pelvic exam chaperoned.

5.) Ask the patient to assume the lithotomy position.

6.) Select an appropriately sized speculum, warmed with water.

7.) Do not lubricate your gloved fingers, as this may intefere with papsmear.

8.) Place two fingers just inside or at the introitus and gently press down on the perineal body.

9.) With your other hand, introduce the closed speculum past your fingers at a 45o angle
downward.

10.) The blades should be held up obliquely and the pressure exerted towards the posterior
vaginal wall, avoiding the more sensitive anterior wall and urethra.
 11.) After the speculum has entered the vagina, remove your fingers from the introitus.

12.) Rotate the blades of the speculum into a horizontal position.

13.) Open the blades after full insertion and maneuver the speculum gently so that the
cervix comes into full view.

 Inspection
• Cervix
• Note the color of the cervix
• Describe the mucous membrane
• Position of Cervix • Cervical os
• Appearance and location
• Mucous membrane
• Note the nature of discharge
•Normal: Cervical os is small and round in nulliparous and slit like after child birth ; The cervix is
covered by smooth pink epithelium.

 Pap Smear -To detect Cervical Cancer

Method Of Exam:

1.) With the blades open, secure the speculum by tightening the thumb screw. Take three
specimens.

2.) Endocervical swab: Insert a cotton applicator stick (wire brush may also be used for
endocervical specimens) into the os of the cervix. Roll the stick gently between the thumb and
index finger. Remove and smear a labelled glass slide.

3.) Cervical scrape: Place the longer end of a cervical spatula into the os of the cervix and press
gently, turn and scrape. Smear a second labelled glass slide. Any bleeding of the cervix during
this procedure should be noted

4.) Posterior fornix: Roll a cotton applicator stick on the floor of the vagina posterior to the cervix.
Smear a third labelled glass slide.

*Take Note: A fixative (usually ang ginagamit ay 95% ethyl alcohol) must be immediately
applied to each slide.*
  Vagina: Speculum Exam of To evaluate the Vagina.

Method of Exam:

1.) Technique
2.) Inspection of vagina is done during withdrawl of speculum after inspection of cervix and after
taking pap smear.
3.) Release the thumb screw first.
4.) Slowly remove the speculum, controlling the degree the blades are opened.
5.) Close the blades as the speculum emerges from the introitus.
6.) During withdrawal, inspect the vaginal mucosa
7.) Inspect Vaginal mucosa for:
-Color, Inflammation, Ulcers, Discharge, Masses

8.) Feel:

 Normal:
• Normal uterus
• is the size of a small orange. When enlarged often described in size corresponding to weeks of
Pregnancy
• Upside down Pear shapedfirm
• smooth surface
• anteverted (80%) and anteflexed.
• freely movable.
• not tender
• Adnexa.
• Ovary 2x2 cms
• Almond shaped
• slightly tender to palpation
• very mobile

Rectovaginal Exam:
To evaluate rectovaginal septum.

• Method Of Exam

• Technique

• Remove the gloves used for vaginal exam. Wear new pair of gloves and lubricate the gloved fingers.

• Slowly reintroduce the index finger into the vagina and the middle finger into the rectum.

• Ask the patient to bear down as the rectal finger is introduced.

• Sweep from side to side and use abdominal hand to bring utereus and adnexa towards vaginorectal
hand
• Feel:

• Examine the rectovaginal septum for thickening, nodularity or tenderness.

• While gently pressing your fingers as superiorly as possible, examine the rectouterine pouch.

• During this procedure, palpate laterally, identifying the right and left uterosacral ligaments and noting
any masses or abnormal tenderness.

• Re-examine both the right and left adnexa with the rectovaginal technique.

• Note: Occasionally, ovarian tumors or cysts may be palpated using this technique, but missed during
the bi-manual exam.

 Fetal Development: Stages of Growth

Within 24 hours after fertilization, the egg that will become your baby rapidly divides into many
cells. By the eighth week of pregnancy, the embryo develops into a fetus. There are about 40 weeks
to a typical pregnancy. These weeks are divided into three trimesters.

 When does a pregnancy start?

The start of pregnancy is actually the first day of your last menstrual period. This is called the
gestational age, or menstrual age. It’s about two weeks ahead of when conception actually occurs.
Though it may seem strange, the date of the first day of your last period will be an important date
when determining your due date. Your healthcare provider will ask you about this date and will use
it to figure out how far along you are in your pregnancy.

 How does conception work?

Each month, your body goes through a reproductive cycle that can end in one of two ways. You will
either have a menstrual period or become pregnant. This cycle is continuously happening during
your reproductive years — from puberty in your teen years to menopause around age 50.In a cycle
that ends with pregnancy, there are several steps. First, a group of eggs (called oocytes) gets ready
to leave the ovary for ovulation (release of the egg). The eggs develop in small, fluid-filled cysts
called follicles. Think of these follicles as small containers for each immature egg. Out of this group
of eggs, one will become mature and continue on through the cycle. This follicle then suppresses all
the other follicles in the group. The other follicles stop growing at this point. The mature follicle now
opens and releases the egg from the ovary. This is ovulation. Ovulation generally happens about two
weeks before your next menstrual period begins. It’s generally in the middle of your cycle.

This secretes (releases) the hormones progesterone and estrogen. Progesterone helps prepare the
endometrium (lining of the uterus). This lining is the place where a fertilized egg settles to develop.
If you don’t become pregnant during a cycle, this lining is what is shed during your period.On
average, fertilization happens about two weeks after your last menstrual period. When the sperm
penetrates the egg, changes occur in the protein coating of the egg to prevent other sperm from
entering. At the moment of fertilization, your baby’s genetic make-up is complete, including its sex.
The sex of your baby depends on what sperm fertilizes the egg at the moment of conception.
Generally, women have a genetic combination of XX and men have XY. Women provide each egg
with an X. Each sperm can be either an X or a Y. If the fertilized egg and sperm a combination of an X
and Y, it’s a boy. If there are two Xs, it’s a girl.

 What happens right after conception?

-Within 24 hours after fertilization, the egg begins rapidly dividing into many cells. It remains in the
fallopian tube for about three days after conception. Then the fertilized egg (now called a
blastocyte) continues to divide as it passes slowly through the fallopian tube to the uterus. Once
there, its next job is to attach to the endometrium. This is called implantation.Before implantation
though, the blastocyte breaks out of its protective covering. When the blastocyte makes contact
with the endometrium, the two exchange hormones to help the blastocyte attach. Some women
notice spotting (slight bleeding) during the one or two days when implantation happens. This is
normal and isn’t something you should worry about. At this point, the endometrium becomes
thicker and the cervix (the opening between your uterus and birth canal) is sealed by a plug of
mucus.

- Within three weeks, the blastocyte cells ultimately form a little ball, or an embryo. By this time, the
first nerve cells have formed.

- Your developing fetus has already gone through a few name changes in the first few weeks of
pregnancy. Generally, it's called an embryo from conception until the eighth week of development.
After the eighth week, it's called a fetus until it’s born.

 How early can I know I’m pregnant?

From the moment of conception, the hormone human chorionic gonadotrophin (hCG) will be
present in your blood. This hormone is created by the cells that form the placenta (food source
for the growing fetus). It’s also the hormone detected in a pregnancy test. Even though this
hormone is there from the beginning, it takes time for it to build within your body. It typically
takes three to four weeks from the first day of your last period for the hCG to increase enough
to be detected by pregnancy tests.

 When should I reach out to my healthcare provider about a new pregnancy?

Most healthcare providers will have you wait to come in for an appointment until you have had
a positive home pregnancy test. These tests are very accurate once you have enough hCG.
- When you call, your healthcare provider may ask you if you are taking a prenatal vitamin. These
supplements contain folic acid. It’s important that you get at least 400mcg of folic acid each day
during a pregnancy to make sure the fetus's neural tube (beginning of the brain and spine)
develops correctly. Many healthcare providers suggest that you take prenatal vitamins with
folic acid even when you aren’t pregnant. If you weren’t taking prenatal vitamins before your
pregnancy, your provider may ask you to start as early as possible.

 What’s the timeline for fetal development?

-The fetus will change a lot throughout a typical pregnancy. This time is divided into three
stages, called trimesters. Each trimester is a set of about three months. Your healthcare
provider will probably talk to you about fetal development in terms of weeks. So, if you are
three months pregnancy, you are about 12 weeks.You will see distinct changes in the fetus, and
yourself, during each trimester.

-Traditionally, we think of a pregnancy as a nine-month process. However, this isn’t always the
case. A full-term pregnancy is 40 weeks, or 280 days. Depending on what months you are
pregnant during (some are shorter and some longer) and what week you deliver, you could be
pregnant for either nine months or 10 months. This is completely normal and healthy.

-Once you get close to the end of your pregnancy, there are several category names you might
hear regarding when you go into labor. These labels divide up the last few weeks of pregnancy.
They’re also used to look out for certain complications in newborns. Babies that are born in the
early term period or before may have a higher risk of breathing, hearing or learning issues than
babies born a few weeks later in the full term time frame. When you’re looking at these labels,
it’s important to know how they’re written. You may see the week first (38) and then you’ll see
two numbers separated by a slash mark (6/7). This stands for how many days you currently are
in the gestational week. So, if you see 38 6/7, it means that you are on day.

 The Last Few Weeks of Pregnancy are divided into the following groups:
• Early term: 37 0/7 weeks through 38 6/7 weeks.
• Full term: 39 0/7 weeks through 40 6/7 weeks.
• Late term: 41 0/7 weeks through 41 6/7 weeks.
• Post term: 42 0/7 weeks and on.
• Talk to your healthcare provider about any questions you may have about gestational age and
due date.
Stages of Growth Month-by-Month in Pregnancy:

• FIRST TRIMESTER
- it will span from conception to 12 weeks. This is generally the first three months of pregnancy.
During this trimester, the fertilized egg will change from a small grouping of cells to a fetus that
is starting to have a baby’s features.

Month 1 (weeks 1 through 4):

• As the fertilized egg grows, a water-tight sac forms around it, gradually filling with fluid. This is called
the amniotic sac, and it helps cushion the growing embryo. During this time, the placenta also develops.
The placenta is a round, flat organ that transfers nutrients from the mother to the fetus, and transfers
wastes from the fetus. Think of the placenta as a food source for the fetus throughout your pregnancy.

• In these first few weeks, a primitive face will take form with large dark circles for eyes. The mouth,
lower jaw and throat are developing. Blood cells are taking shape, and circulation will begin. The tiny
"heart" tube will beat 65 times a minute by the end of the fourth week.

• By the end of the first month, the fetus is about 1/4 inch long – smaller than a grain of rice.

Month 2 (weeks 5 through 8):

• Facial features continue to develop. Each ear begins as a little fold of skin at the side of the head. Tiny
buds that eventually grow into arms and legs are forming. Fingers, toes and eyes are also forming.

• The neural tube (brain, spinal cord and other neural tissue of the central nervous system) is well
formed now. The digestive tract and sensory organs begin to develop too. Bone starts to replace
cartilage.

• The head is large in proportion to the rest of the body at this point. At about 6 weeks, a heartbeat can
usually be detected.

• After the 8th week, healthcare providers refer to it as a fetus instead of an embryo.

• By the end of the second month, the fetus is about 1 inch long and weighs about 1/30 of an ounce.

Month 3 (weeks 9 through 12):

• The arms, hands, fingers, feet and toes are fully formed. At this stage, the fetus is starting to explore a
bit by doing things like opening and closing its fists and mouth. Fingernails and toenails are beginning to
develop and the external ears are formed. The beginnings of teeth are forming under the gums. The
reproductive organs also develop, but sex is still difficult to distinguish on ultrasound.

• By the end of the third month, the fetus is fully formed. All the organs and limbs (extremities) are
present and will continue to develop in order to become functional. The circulatory and urinary systems
are also working and the liver produces bile. At the end of the third month, the fetus is about 4 inches
long and weighs about 1 ounce.

*TAKE NOTE: Since the most critical development has taken place, your chance of miscarriage drops
considerably after three months.*
• SECOND TRIMESTER
- This middle section of pregnancy is often thought of as the best part of the experience. By this
time, any morning sickness is probably gone and the discomfort of early pregnancy has faded.
The fetus will start to develop facial features during this month. You may also start to feel
movement as the fetus flips and turns in the uterus. During this trimester, many people find out
whether their baby will be designated male or female at birth. This is typically done during an
anatomy scan (an ultra sound that checks physical development).

Month 4 (weeks 13 through 16):

• The fetal heartbeat may now be audible through an instrument called a doppler. The fingers and
toes are well-defined. Eyelids, eyebrows, eyelashes, nails and hair are formed. Teeth and bones
become denser. The fetus can even suck his or her thumb, yawn, stretch and make faces.The
nervous system is starting to function. The reproductive organs and genitalia are now fully
developed, and your doctor can see on ultrasound if the fetus will be designated male or female at
birth.By the end of the fourth month, the fetus is about 6 inches long and weighs about 4 ounces.

Month 5 (weeks 17 through 20):

• At this stage, you may begin to feel the fetus moving around. The fetus is developing muscles and
exercising them. This first movement is called quickening and can feel like a flutter.

• Hair begins to grow on the head. The shoulders, back and temples are covered by a soft fine hair
called lanugo. This hair protects the fetus and is usually shed at the end of your baby's first week of
life.

• The skin is covered with a whitish coating called vernix caseosa. This "cheesy" substance is thought
to protect fetal skin from the long exposure to the amniotic fluid. This coating is shed just before
birth.

• By the end of the fifth month, the fetus is about 10 inches long and weighs from 1/2 to 1 pound.

Month 6 (weeks 21 through 24):

• If you could look inside the uterus right now, you would see that the fetus's skin is reddish in
color, wrinkled and veins are visible through translucent skin. The finger and toe prints are visible. In
this stage, the eyelids begin to part and the eyes open.

• The fetus responds to sounds by moving or increasing the pulse. You may notice jerking motions if
the fetus hiccups.

• If born prematurely, your baby may survive after the 23rd week with intensive care.

• By the end of the sixth month, the fetus is about 12 inches long and weighs about 2 pounds.
 Month 7 (weeks 25 through 28):

• The fetus continues to mature and develop reserves of body fat. At this point, hearing is fully
developed. The fetus changes position frequently and responds to stimuli, including sound, pain and
light. The amniotic fluid begins to diminish.

•If born prematurely, your baby would be likely to survive after the seventh (month??) putol ulit
bwisit pero feeling ko seventh month nga kayo na bahala mag research hehe

• THIRD TRIMESTER
- This is the final part of your pregnancy. You may be tempted to start the countdown till your
due date and hope that it would come early, but each week of this final stage of development
helps the fetus prepare for birth. Throughout the third trimester, the fetus gains weight quickly,
adding body fat that will help after birth. Remember, even though popular culture only
mentions nine months of pregnancy, you may actually be pregnant for 10 months. The typical,
full-term pregnancy is 40 weeks, which can take you into a tenth month. It’s also possible that
you can go past your due date by a week or two (41 or 42 weeks). Your healthcare provider will
monitor you closely as you approach your due date. If you pass your due date, and don’t go into
spontaneous labor, your provider may induce you. This means that medications will be used to
make you go into labor and have the baby. Make sure to talk to your healthcare provider during
this trimester about your birth plan.

Month 8 (weeks 29 through 32):

• The fetus continues to mature and develop reserves of body fat. You may notice more kicking. The
brain developing rapidly at this time, and the fetus can see and hear. Most internal systems are well
developed, but the lungs may still be immature.The fetus is about 18 inches long and weighs as
much as 5 pounds.

Month 9 (weeks 33 through 36):

• During this stage, the fetus continues to grow and mature. The lungs are close to being fully
developed at this point.

• The fetus has coordinated reflexes and can blink, close the eyes, turn the head, grasp firmly, and
respond to sounds, light and touch.

• The fetus is about 17 to 19 inches long and weighs from 5 ½ pounds to 6 ½ pounds.

Month 10 (Weeks 37 through 40):

• In this final month, you could go into labor at any time. You may notice that less movement
because space is tight. At this point, The fetus's position may have changed to prepare for birth.
Ideally, it's head down in your uterus. You may feel very uncomfortable in this final stretch of time
as the fetus drops down into your pelvis and prepares for birth.

• Your baby is ready to meet the world at this point. They are about 18 to 20 inches long and weigh
about 7 pounds.

*Stay safe guys at good luck!****

T
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