Pregnancy

Pregnancy
By
Sr. Siti Norhaiza Hadzir
 Pregnancy
• If ovum is fertilized it may implant in
endometrium
• The function of LH is taking over by
human chorionic gonadotrophin (HCG)
• HCG is produced by placenta
• HCG prevent the involution of corpus
luteum
• Estrogen and progesteron raises and
endometrium sloughing is prevented
• Prolactin secretion increased after
eight weeks of pregnancy
• Prolactin, estrogen and progesteron
stimulates breast development
• High plasma estrogen inhibit milk
production
 Fertilization
• Occur at the end of Fallopian tube
• Sperm motility is important
• Sperm half life 2-3 days
ovum 24 hours
• Pregnancy is counted from the first
day of last menses.
• Baby is almost 2 weeks younger than
pregnancy period.
• The duration is 9 months 10 days/280
days/40 weeks
• Zygote (ovum + sperm) is brought to
the uterus (within 4 days fertilization)
• Endometrial stabilization —amenorrhea.
• Human chorionic gonadotrophin (HCG)
can be detected after 10 days
fertilization.
• Positive pregnancy test.
 Maternal Changes
• Weight gain (10-12 kg)
• Changes in the pelvic
• Cardiovascular changes
increase in stroke volume/ cardiac
output/heart rate/blood volume
• Changes in pulmonary function- to
supply oxygen to the fetus.
• Cause dyspnea
• The effect of pressure to the abdomen
Veracious vein
Renal hypertension
gastritis (slowing in motility)
Leg edema
• Increase in the rate of metabolism
• Decrease GIT motility– constipation,
nausea, vomiting
• Skin-chloasma, linea alba, striae,
• Fat deposition especially
triglyceride
• Hypervolemia
• Increase in erytropoiesis
Monitoring pregnancy
 Aim
• To detect fetus abnormality
• To monitor the progress of
pregnancy
 Monitoring pregnancy
• HCG reaches peak at 13 weeks of
pregnancy
• Crude test of plasma and urine HCG
give positive result after one or two
weeks of missed period.
• Immunoassay detected soon after
implantation of ovum for pts treated
for infertility
• Human placenta lactogen (HPL)
produced at eight weeks of
pregnancy. To assess abortion or late
pregnancy
• Now assessment of fetal well being is
replace mainly by Ultrasound
 Amniocentesis
• To obtained amniotic fluid
• Needle is inserted into uterus
through maternal abdomen
• Done after 14 weeks of pregnancy
• Done together with U/sound guide
• Perform only for strong clinical
indication and if diagnosis cannot be
made by un-invasive procedure
• Avoid
– Specimen contaminated with maternal, or
fetal blood and urine
– Not fresh
 Amniocentesis
• Detection of neural tube defect
– AFP to detect neural tube defect such as
spinal bifida, anencephaly
– Alpha fetoprotein is produced by liver
and yolk sac
– AFP can also caused by multiple pregnancy
• Down Syndrome
– Low AFP and raised HCG measured
between 16-18 weeks
• Assessment of fetomaternal blood
group incompatibility
– Measure fetus bilirubin
 Maternal Biochemical
changes
• Increased in carrier protein
– Increase in Total T4 and Cortisol (TBG and
CBG high, Free T4 and cortisol normal),
• Increased transferrin or TIBC
• Increased ALP (placenta isoenzyme)
• Low Protein and albumin (dilution)
• Glucosuria (increased GFR)
• Low calcium (bcause bind to albumin)
Pregnancy
Pregnancy and
and disease
disease
Pregnancy
Pregnancy induced
induced
hypertension
hypertension
 PIH
• also be called preeclampsia
• pregnancy complication
• Characterized by high blood pressure,
oedema and proteinuria.
• One out of every 14 pregnant women
• Can also occur in subsequent pregnancies
• More common in pregnant teens and in
women over age 35
• develops usually after the 20th week, but
it can also develop at the time of delivery
or right after delivery.
 Symptoms
• Rapid or sudden weight gain
• High blood pressure.
• Protein in the urine.
• Swelling* in the hands, feet and face
• Severe headaches
• Change in reflexes
• Reduced output of urine or no urine
• Blood in the urine
• Excessive vomiting and nausea.
 Who is at risk of
• Is under age 20 or over age 35
• Has a history of chronic hypertension
• Has a previous history of PIH
• Has a female relative with a history of PIH
• Is underweight or overweight
• Has diabetes before becoming pregnant
• Has an immune system disorder, such as lupus or
rheumatoid arthritis
• Has kidney disease
• Has a history of alcohol, drug or tobacco use
• Is expecting twins or triplets
What is the danger of PIH?
• PIH can prevent the placenta from
receiving enough blood, which can cause low
birth weight in the baby.
• Placental abruption, a complication that
occurs when the placenta pulls away from
the wall of the uterus
• Severe bleeding
• Seizures
• Early delivery of premature baby
• Stillbirth
 How is PIH treated?
Mild PIH
• Can be treated at home.
• Need to maintain a quiet, restful
environment with limited activity or bed
rest.
• Follow the diet and fluid intake guidelines.
• Maintain scheduled Clinic appointments.
• Constant perception of fetal movement is
also important.
 Severe PIH

• Hospitalization for closely monitoring.

• Health care provider will work with pt to
maintain the health of mother and the
baby.
• In severe cases, the baby may have to be
delivered.
• Both severe and mild PIH pt is given
antihypertensive drugs.
GESTATIONAL
GESTATIONAL
DIABETES
DIABETES
 Definition
• Gestational diabetes is a type of
diabetes that occurs only during
pregnancy.
• Like other forms of diabetes,
gestational diabetes affects the way
the body uses blood glucose
• Blood sugar level is too high.
 Causes
• During pregnancy, the placenta produces hormones
that prevent insulin action.
• These hormones, which include estrogen, cortisol
and human placental lactogen, are vital to
preserving pregnancy.
• Yet they also make the cells more resistant to
insulin.
• As the placenta grows larger in the second and
third trimesters, it secretes even more of these
hormones, further increasing insulin resistance.
• Normally, the pancreas responds by producing
enough extra insulin to overcome this resistance.
• During pregnancy, the body need up to 3x
as much insulin as normal, and sometimes
the pancreas simply can't keep up.
• When this happens, intracellular glucose is
decrease, and too much stays in the blood.
• It usually occurs about the 20th to 24th
week of pregnancy and can be measured by
the 24th to 28th week of pregnancy.
• Blood sugar levels should quickly return to
normal after delivery.
 Risk factors
• Age more than 25 yrs old
• Family or personal history of
diabetes
• Overweight before pregnancy
• Previous complicated pregnancy.
Unexplained stillbirth or a baby who
weighed more than 9 pounds.
 Screening and diagnosis
• A urine sample isn't a reliable indicator of
gestational diabetes because the amount of sugar
in urine can vary throughout the day and as a
result of dietary
• In some places, screening for gestational diabetes
is a routine part of prenatal care for all women.
• To screen for gestational diabetes, most doctors
recommend a glucose challenge test (OGTT).
• This test is usually done between 24 and 28 weeks
of pregnancy, because the condition usually can't
be detected until then.
• However, if pts are at risk, the test may be
performed earlier.
 Complications (baby)
• Macrosomia –big baby, a birth weight of
4.5kg (9 pounds, 14 ounces)
• Shoulder dystocia. Baby is too big to
move through the birth canal.
• Hypoglycemia. Sometimes babies of
mothers with gestational diabetes develop
low blood sugar (hypoglycemia) shortly
after birth
• Stillbirth or death
 Complications to mothers

• Preeclampsia.
• Operative delivery
• Gestational diabetes in another
pregnancy
• Type 2 diabetes as they get older
 Treatment
• Controlling blood sugar is essential to
keeping the baby healthy and avoiding
complications during delivery.
• Most women with gestational diabetes are
able to control their blood sugar with diet
and exercise.
• Some may need anti-diabetic drug.
• Monitoring blood sugar will tells whether
blood sugar is staying within a normal
range.
 Patients Monitoring
• Monitoring own blood sugar.
• Eating healthy diet
• Diet consultation
• Regular exercises
• Taking medications (glyburide, metformin
may be safe and effective)
• Baby monitoring (prevent the pregnancy
from going longer than 40 weeks-complication)
HYPEREMESIS
HYPEREMESIS
GRAVIDARUM
GRAVIDARUM
• Hyperemesis gravidarum is a severe
and intractable form of nausea and
vomiting in pregnancy.
• The peak incidence is at 8-12 weeks
of pregnancy, and symptoms usually
resolve by week 16.
• It is a diagnosis of exclusion and may
result in weight loss; nutritional
deficiencies; and abnormalities in
fluids, electrolyte levels, and acid-
base balance, acidosis.
• The prevalence increases in molar
pregnancies (hidatidiform mole) and
multiple pregnancies.
• The incidence is higher in younger
women than in older women
ANEMIA
ANEMIA IN
IN
PREGNANCY
PREGNANCY
• The most common cause of anemia in
pregnancy is iron deficiency.
• The baby will really start to draw on
iron reserves around week 20.
• Type hypocromic normocytic
 Clinical features
• being tired
• feeling weak
• pale skin
• palpitations
• breathlessness
• fainting spells
• 15mg of iron per day pre-conception
• Many women who aren't pregnant do
not even reach the RDA each day.
• Pregnant women need almost twice
the amount of iron per day.
• Taking iron supplements can often cause
constipation, nausea and vomiting,
• Iron-Rich Foods
liver
spinach
dried fruits
• Maximize Your Iron Absorption
Taking vitamin C-rich foods along with the
iron will increase absorption of the iron.
However, taking caffeinated beverages
along with high-iron foods will reduce the
amount of iron that your body absorbs.
Thank you