LESSON 3 – PREGNANCY

DEFINITION OF TERMS CATEGORIES OF PREGNANCY SIGNS

1. Presumptive Signs
Obstetrics
2. Probable Signs
→ Branch of medicine
3. Positive Signs
→ Deals with childbirth and the care and treatment of the
mother before and after birth. PRESUPMPTIVE SIGNS
• Least predictive of pregnancy
Fertilization
• Subjective and cannot be assessed by the examiner.
→ The union of the sperm and the ovum.
• Only the woman can feel the signs.
Labor (Childbirth) • Has the capacity of having that possible presumption that
→ The expulsion of the products of conception pregnancy is present.
(conceptus) from the uterus when it has reached the
stage of viability FOLLOWING ARE THE PRESUMPTIVE SIGNS:
→ Abortion • Morning Sickness (Nausea and Vomiting)
➢ Coming out of the fetus before 20 weeks. ➢ This can occur during day; not only in the morning.
➢ In positive pregnancies, it can usually be
Puerperium experienced during the first month but it can last
→ Postpartum period of 4 to 6 weeks all throughout the pregnancy.
→ When the genital organs of the mother return to their • Amenorrhea (Absence of Menstrual Period)
pre-gravid (before pregnancy) state. ➢ You get to miss your menstrual period.
➢ However, this sign doesn't definitely mean that
Gynecology one is pregnant.
→ Branch of medicine o There are conditions, especially
→ Deals with the diseases of the non-pregnant woman. hormonal imbalances or problems, that
can cause amenorrhea.
Obstetrician • Breast Changes
→ A doctor of medicine specializing in obstetrics. • Fatigue
➢ This is the feeling of extreme tiredness.
Midwife ➢ Sometimes, it is also the result of extreme stress
→ Person who attends to deliveries (particularly normal and physical exertion.
deliveries) • Lassitude (Lethargy or Lack of Energy)
→ They are not doctors. ➢ Interchangeable with fatigue.
➢ You have that feeling of lethargy or you lack
Obstetrics or OB/GYN Nurse energy to do something.
→ Cares for women during pregnancy, labor, childbirth, • Urinary Frequency (Frequent Urination)
and other reproductive health issues. • Quickening
➢ Movement in the uterus or abdomen.
PREGNANCY ➢ For primigravida, movement of fetus can be felt at
• Term used to describe the period in which the fetus around 18 weeks.
develops inside a woman's womb or uterus. ➢ For multigravida, can be felt as early as 16 weeks.
• Lasts for about 40 weeks or just over 9 months. • Food Cravings and Aversions
• This can be measured from the Last Normal Menstrual • Mood Changes or "Mood Swings"
Period from the woman.
• We can later on calculate for the: PROBABLE SIGNS
➢ Expected Date of Confinement (EDC) • Can be documented by examiner.
➢ Estimated Date of Delivery (EDD)
• Can be a probable indication of pregnancy.
• Healthcare providers use three (3) segments in order to
• However, it cannot confirm the pregnancy.
check and monitor the pregnancy.
• It can be observed by the examiner.
➢ This is called as the trimester.
• Can be an indication that pregnancy is present.
➢ These trimesters will help us later on identify the
possible development. • If you have these signs, there is a likelihood of pregnancy.
➢ It can also help us monitor the growth and
development of the pregnancy and the wellness of FOLLOWING ARE THE PROBABLE SIGNS:
the fetus. • Uterine Changes
• Also defined as the period before childbirth from the ➢ Uterine enlargement
moment of conception or fertilization to the start of labor. ➢ Uterine softening (Hegar's Sign)
o This is where the lower uterine segment
COMMON & EARLY SIGNS OF PREGNANCY (LUS) of the uterus starts to soften.
• Missed periods o Lower uterine segment becomes softt.
• Breast soreness o Usually, this happens at around 6 to 12
• Increased basal body temperature weeks of gestation.
• Morning sickness ➢ Ballottement Sign
• Frequent urination o Bouncing back of the fetus
• Fatigue o It is demonstrated during manual
examination.
o Examiners can determine the
COMMON DISCOMFORTS OF PREGNANCY
Ballottement Sign because of the
• Nausea
rebound movement.
• Indigestion
• Cervical Changes
• Breast tenderness ➢ Goodell's Sign
• Frequent urination o The softening of the cervix.
• Headaches o Happens also at around 6th to 8th weeks.
• Backache o Can be examined or assessed during the
• Sweating 6th to 12th week

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 ➢ Braxton - Hicks Contraction
o Painless contractions occurring all
throughout the pregnancy
o Sometimes considered as false labor
contractions that are not regular and will
not result in cervical dilation or childbirth.
• Positive Pregnancy Test
➢ Sometimes does not confirm pregnancy
➢ There are times where the pregnancy test turns
out positive because of the HCg levels in the urine
or blood specimen.
➢ Take note of conditions such as ectopic
pregnancy.
• Chadwick's Sign
➢ It is a discoloration in the vaginal wall or vulva of
the patient.
➢ A medical provider is more likely to observe a
bluish discoloration of the vaginal wall.
• Outlining of Fetal Body
➢ Examiner may sometimes feel a fetal outline or
body that they can palpate.
➢ It does not confirm pregnancy.
o There are cases like tumors, cysts, etc.
POSITIVE SIGNS
• Those which cannot be mistaken for any other condition.
• They are considered absolute evidence of pregnancy.
• Definitive signs of pregnancy.
• Confirmation signs or confirmatory signs
• Unmistakable signs of pregnancy; only 3 confirmatory signs
FOLLOWING ARE THE POSITIVE SIGNS:
• Fetal Heart Rate
➢ When you use the different devices to listen to the
fetal heart rate, you are able to identify whether
patient is pregnant or not.
➢ Common device used is the fetal doppler.
o When you use this, by 10 weeks of
gestation, you get to hear the fetal
heartbeat already.
➢ A fetoscope, though already uncommonly used in
the medical setting, can be used to check for the
heartbeat of the fetus.
o By 16 weeks, you can utilize the
fetoscope in checking for the fetal
heartbeat.
o Using a normal stethoscope, it is by 18 to
20 weeks that we can hear the fetal
heartbeat.
➢ Normal Fetal Heart Rate: 160 to 120 bpm
• Fetal Movement
➢ Can be examined by a health care provider,
usually after 20 weeks of gestation.
➢ Pregnant mother will also be able to feel kicks,
flutters, or several various movements in the
womb.
➢ By the later part of the 2nd trimester of the
pregnancy, these fetal movements become
stronger and regular.
o And these are the causes as to why the
mother is not or would be not able to
sleep.
• Fetal Outline on Ultrasound
➢ Confirmatory test that indicates that pregnancy is
present.
➢ Ultrasound will later on detect the fetus and helps
in the visualization of the fetus.
➢ Also helps in the assessment of the patient or of
the fetus' well-being and development.
o We can check how the fetus is
progressing.
o We can also check if there are problems
or complications.
➢ Allows us to determine the gender of the fetus.
PHYSIOLOGIC EFFECTS OF PREGNANCY
• Pregnancy is associated with normal physiological changes
that assist fetal survival as well as preparation for labor.
REPRODUCTIVE SYSTEM
• Uterus change to globular in shape
➢ As pregnancy progresses, uterus leaves the pelvic
cavity as it will ascend to the abdominal cavity.
➢ Because of that, uterus changes in a globular
shape.
• Softening of the uterus occurs (Hegar's Sign)
• Presence of Uterine Contraction (Braxton - Hick's)
• Uterine Souffle and Funic Souffle Dominant
➢ Blowing Sound
➢ These are examples of a swishing or a blowing
sound produced.
➢ These are present because of the rush of blood
through the dilated vessels of the uterus.
➢ During auscultation, uterine souffle may often be
confused because of the whiffling sound and it is
synchronous with the pulse of the fetus.
➢ Only occurs during the pregnancy.
• Softening of the cervix (Gooddell's Sign)
• Leukorrhea is noticeable
• Operculum (Mucous Plug) is present
➢ Acts as a protection against bacteria that would
like to enter the uterus.
➢ Also acts as a barrier in order to protect the uterus
from any ascending infection.
• Fullness of breast, tingling sensation, and heaviness
• Montgomery's Tubercle is prominent
➢ It lubricates the nipples.
➢ Also alerts the baby when its time to eat.
➢ Usually changing in size because of the hormones
RESPIRATORY SYSTEM
• Increase maternal O2 requirements
• Hormonal changes in pregnancy affect the Upper
Respiratory Tract (URT) and Upper Airway Mucosa
• Diaphragm function remains the same
• The enlarging uterus and hormonal effects produce
anatomical changes in the thoracic cage
➢ Respiratory changes during pregnancy are
important to accommodate and meet the demands
of the mother and the fetus.
• Difficulty of Breathing (DOB)
• Increased Respiratory Rate
GASTROINTESTINAL SYSTEM
• Morning sickness
➢ Severe Form: Hyperemesis Gravidarum
• Constipation
➢ Relaxin contributes to decreased gastric motility.
➢ Relaxin hormone is produced by the ovary and the
placenta.
o Very important for the female
reproductive system during pregnancy.
➢ It is also most likely to happen due to the increase
in the hormone progesterone.
o It relaxes the muscles the body and also
decreases the motility.
o Relaxes the motions in the intestines
o Slower moving intestines = Lower
digestion
• Heartburn influenced by relaxin and progesterone
➢ Mother may experience this due to the reflux of
stomach contents into the esophagus that will
cause the upward displacement of the stomach
products and the relaxed cardioesophagal
sphincter.
• Hemorrhoids
• Because of the pressure of the uterus to the veins returning
from the lower extremities.
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 INTEGUMENTARY SYSTEM PREGNANCY HIGHLIGHTS PER SEMESTER
• Appearance of Striae Gravidraum Melasma/Chloasma
• Linea nigra = Seen in the midline of the abdomen FIRST TRIMESTER
• Vascular Spiders of Telangiectasis • Early pregnancy (Weeks 1 to 12)
• Most critical stage because all major organs begin to form
CARDIOVASCULAR SYSTEM • Baby now receives good and harmful substance from the
• Body water rises mother
➢ There's an increase in blood volume ➢ Through the umbilical cord
➢ Usually starts during the first trimester • The heartbeat can be usually seen around 6 weeks via the
• Blood volume increases by 25% to 45% ultrasound and heard around 9 weeks via doppler.
➢ There is also an increase in iron consumption or
iron requirement SECOND TRIMESTER
o Reason why, during pregnancy, mother
• Starts at the 13th week and ends at week 27 of pregnancy.
is given supplementation of iron, folic
• Bone cells replace cartilage; all parts of the body mature.
acid, and vitamin.
o Because anemia is a possible condition • Overall size quickly increases.
that might happen. • Quickening occurs
• Blood Pressure and Pulse increase ➢ Mother feels the baby move for the first time
➢ Because of the increased cardiac output, there will ➢ 4th or 5th month (or 16 to 20 weeks)
also be some changes in the heart rate of the • Referred to as the "best time" in pregnancy for mom.
mother. ➢ Gender reveals can now happen
o There will also be a possibility of ➢ Baby begins to hear different sounds during 2nd
palpitations sometimes. trimester.
• Varicose Veins are common
➢ Due to the increased cardiac demand in the body. THIRD TRIMESTER
• Starts at 27 weeks and ends at birth.
URINARY SYSTEM ➢ 40 weeks is standard.
• Kidneys have additional burden and produce more urine • Age of viability: most babies could survive if they were born
➢ Kidneys will also increase in size and function (around 28 weeks)
➢ Ureter will also enlarge • Baby is fully developed and just needs to grow and mature
➢ Later in pregnancy, pregnant woman might also in order to be ready for its big debut.
experience physiological hydronephrosis or • During the 9th month, the placenta provides antibodies to
ureteronephrosis help protect the baby and the lungs are now mature.
o These are common conditions present in
a pregnant woman. MINOR DISCOMFORTS IN PREGNANCY
➢ Increase in sodium retention. 1. Nasal Congestion
➢ Edema might be present due to water retention. 2. Nausea and Vomiting
• The uterus compresses the bladder 3. Palpitations
➢ Urinary frequency is also present because in the 4. Breast Tenderness
late stage of pregnancy, the uterus will now 5. Shortness of Breathing
compress the bladder. 6. Backache
7. Abdominal Discomfort
SKELETAL SYSTEM 8. Braxton Hick’s
• Calcium and Phosphorous 9. Urinary Frequency
➢ Calcium and phosphorus needs are increased 10. Constipation
➢ There will be softening of the ligaments and joints 11. Leukorrhea
• Softening of the pelvis 12. Hemorrhoids
➢ Due to increased progesterone and relaxin 13. Muscle Cramps
(ovarian hormone) 14. Varicose Veins
➢ To facilitate passage of baby through the pelvis 15. Ankle Edema
➢ In preparation of the delivery of the baby
• Separation of symphysis pubis by the 32nd week of ASSESSING FETAL WELL-BEING
pregnancy • These are some of the assessment tools and procedures
➢ About 3 mm to 4 mm that we get to perform and acquire during the course of the
• Change of weight pregnancy.
➢ Cause the "pride of pregnancy" (Lordosis)
➢ You start to stand a little bit straighter and taller ULTRASOUND (UTZ)
because it facilitates easier ambulation. • UTZ Dating of pregnancy is more accurate in early
• This somehow leads to backache. pregnancy.
• A biparietal diameter (BPD) of 9.5 cm indicates a more
ENDOCRINE SYSTEM mature fetus.
• Changes in Progesterone and Estrogen Levels ➢ Usually attained at 36 weeks gestation.
➢ Estrogen is one of the hormone that affects breast • Accurate and reliable
and uterine enlargement; also increases sodium • We can also check for the head circumference, abdominal
and water retention. circumference, estimated fetal weight, and the femur
➢ It also affects fat deposit and blood coagulation length.
➢ Progesterone is responsible in the possibility for • Biparietal Diameter (BPD)
uterine contractility – Avoids contraction ➢ Biometric parameters to assess fetal size.
➢ Progesterone also maintains the endometrium
and helps in the development of lactation.
• Increased HCg (Human Chorionic Gonadotropin) Levels
➢ Result of estrogen and progesterone synthesis
➢ Serve as an antagonist to insulin effect
➢ Because of this antagonist effect, glucose will be
more available for fetal growth.
• No production of LH and FSH
➢ This is due to the amount of estrogen and
progesterone that has increased
• Increased melanocyte stimulating hormone
• Oxytocin is produced in late pregnancy
• Prolactin stimulate lactation

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 DOPPLER FETAL MONITOR
• A hand-held ultrasound transducer used to detect the fetal
heartbeat for prenatal care.
• It uses the Doppler effect to provide and audible simulation
of the heartbeat.
• Some models also display the heart rate in beats per
minute.
• May help us detect changes in the normal heart rate pattern
during labor.
➢ If there are any changes detected, steps can be
taken to treat the underlying problem.

CARDIOTOCOGRAPHY (CTG)
• Also measures the baby's heart rate.
• At the same time, it also monitors the contractions in the
womb.
• Used before and during labor to monitor the baby for any
signs of distress.
• By looking at the various aspects of the baby's heart rate,
health care providers can see how the baby is coping.
• A technical means of recording FHB and uterine
contractions through EFM or Electronic Fetal Monitor
• Reassuring if accelerations occur with fetal movement.
• Being advised because of the following conditions:
➢ Maybe baby is coming earlier
➢ Baby is smaller than expected
o Baby needs thorough monitoring
➢ Patient may have high blood pressure
➢ Patient has an infection
➢ Patient is expecting twins or more
➢ Patient or baby has passed meconium already
and it is seen in the amniotic fluid

Meconium
→ The very first bowel movement of the baby but baby is
still inside the womb
→ May later on develop into sepsis or severe infection.

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