NORMAL PREGNANCY

1. Physiological Changes of Pregnancy

• All changes in the mother's body during pregnancy are due to the
hormones. These changes enable her to mature the fetus, prepare
her body for labor, develop the breasts and lay down stores of fat
to provide calories for production of breast milk during
puerperium.

1.1. Physiological Changes in the Uterus

• After conception the uterus develops a nutritive and protective

environment, in which the fetus can develop and grow.

• It increases from the size of a small pear in its non-pregnant state

Cont……
Height of the Uterus at Various Weeks of Pregnancy
• At 12th weeks of pregnancy the fundus of the uterus may be
palpated abdominally above the symphsis pubis
• At 16th week midway between umbilicus and symphysis pubis
• At 20th week at the level of umbilicus
• At 30th week midway between umbilicus and xiphisternum
• At 38th week at the level of xiphisternum
• At 40th week below xiphisternum
Cont…..

1.2. Physiological Change in the Cervix

• Under the influence of progesterone the cells in cervix

produces mucus which becomes thicker and more vicious
during pregnancy and this thick mucus we call it operculum.

1.3. Physiological Change in the Vagina

• The vagina also becomes more elastic towards the end of

pregnancy, the normal white vaginal discharge during
pregnancy known as leucorrhoea.
Cont……
1.4. Changes in the Cardiovascular System

• The maternal blood volume and the number of red blood cells

increase during pregnancy because of extra oxygen requirements.

The heart may increase in size during pregnancy due to an

increase in its workload.

1.5. Iron Metabolism

• The concentration of red blood cells and hemoglobin will fall

because they are more dilute (hemodillution), so the woman’s

blood will be slightly anemic (Physiological Anemia)

Cont….

1.6. Oedema in Pregnancy

• A combination of the slight increase in the permeability

of the smallest of blood vessels, the additional weight of

the uterus and the downward force of gravity, slow down

the rate at which blood is pumped back to the heart from

the lower half of the body.

Cont….

1.7. Changes in the Urinary System

• The kidneys extract waste from the blood and turn it into

urine. They must work extra hard to filter the mother’s

own waste products from her blood, plus those of the

fetus. Therefore, there is also an increase in the amount of

urine.

• Needing to urinate often is normal, especially in the first

and last months of pregnancy.

Cont…..

1.8. Effects on the Blood Pressure

• Blood pressure remains the same or drops slightly during the

first trimester and reaches its lowest level in mid trimester, this

may cause fainting. Changes in blood pressure are due to

increased progesterone production

1.9. Respiratory Changes

• During pregnancy, many women find they get short of breath.

This is because the growing baby crowds the mother’s lungs

and she has less room to breathe.

Cont…..

1.10. Changes in the Gastrointestinal System

• Progesterone relaxes the smooth muscles in the gut,

Gastric emptying and peristalsis are slowed, As the

pregnancy progresses, the growing baby crowds the

mother’s stomach and pushes it higher than usual, they

cause a burning feeling (heart burn).

Cont……

1.11. Skeletal Changes

• Progesterone and relaxin encourage the relaxation of

ligaments and muscles and reach their maximum effect

during the last weeks of pregnancy.

1.12. Maternal Weight

• An expected increase of 2 kg in the first 20 weeks and

about 0.5kg per week until term is usual.

Cont….
1.13. Skin Changes

• Lineanigra: This dark line may appear between the

umbilicus and the symphysis pubis.

• Mask of pregnancy (chloasma): Some women produce a

brownish pigmentation of the skin over the face and

forehead.

• Stretch marks: Pink or brownish stretch marks

(striegravidarum) may appear in some women.

Cont…..
1.14. Sweat Glands
• Sweat glands throughout the body usually increases
during pregnancy, which causes the woman to perspire
(sweat) more profusely than usual.
1.15. Changes in the Endocrine System
• Human placental lactogen hormone alters the maternal
metabolism and increasing levels of circulating blood
glucose.
Cont…..
1.16. Pituitary Hormones
• The anterior pituitary gland is enlarged and hormones
produced in the anterior gland are increased.
• The posterior part of the gland is stimulated to produce
increased amounts of oxytocin during pregnancy.
1.17. Changes in the Breasts
• In early pregnancy, the breasts may feel full or tingle, and they
increase in size as pregnancy progresses.
• The areola darkens and the diameter increases. By the 16 th
week Prolactin stimulates the production of colostrums.
Cont……

1.18. Pregnancy Related Changes in Posture and Joints

• A pregnant woman’s entire posture changes as the baby gets

bigger.

• Her abdomen transforms from flat (concave) to very convex

(bulging outwards).

1.19. Exercise and Blood Flow in Pregnancy

• Nonviolent exercise is good for the mother because it

prepares her body for labour, A pregnant woman should not

do exercises where she is lying on her back.
Diagnosis of Pregnancy
1. Possible (Presumptive) Symptoms of Pregnancy
• The possible symptoms commonly reported by women in the
early stages of pregnancy, by the health professional on the
basis of these subjective reports:-
 Missing a Menstrual Period (Amenorrhea)

 Breast Changes

 Morning Sickness

 Frequent Urination

 Quickening (1st fetal movement felt by the mother)

Cont…..
2. Probable Signs and Symptoms of Pregnancy
These are more reliable than the possible symptoms, but they are not certain indicators of pregnancy, these are:-

 Abdominal Enlargement  Internal Ballottement

 Hegars Sign  Softening of the Cervix

 Changes in the Uterus  Pregnancy Test for
 Braxton Hick’s Contraction Human Chorionic
 Uterine Soufflé Gonadotropin (HCG)
Cont……..
3. Positive Signs of Pregnancy
• A positive diagnosis of pregnancy called ‘sure’ signs,
these are:
Fetal Heart Beat (FHB)
Palpation of the Fetus
Ultrasound Examination
Calculation of Estimated Date of Delivery (EDD) and Gestational Age

(GA)

1. Methods to Calculate EDD

• Each month in Ethiopian calendar has 30 days. And each year has 13

months. i.e. 9 X 30 = 270 days.

• To full fill 280 days you use the following three methods:

 You added 10 days if this pregnancy does not pass pagume.

 If this pregnancy can pass pagume and pagume is 5 you add 5

days.

 If this pregnancy can pass pagume and pagume is 6 you add 4

2. Estimation of Gestational Age (GA)

2.1. Pregnancy Calendar or Calculator

• The estimated age of the fetus calculated from the first day of the

last (normal) menstrual period (LMP), assuming a 28-day cycle.

• Calculation of Gestational age in weeks from the given LMP is

based on the following assumptions:

 The average duration of a human pregnancy is 280 days or

10 lunar month Or 40 weeks

 To calculate gestational age in weeks first you have to know

the LNMP of the women and date of arrival for
examination.
2.2. Clinical Parameters of Gestational Age

• Uterine Size: See at physiological change in uterus

• Quickening: In primigravida at GA 18-20 weeks and in

multigravida at GA 16-18 weeks)

• Fetal Heart Tones: FHTs may be heard by fetoscope at

20 weeks, where as Doppler ultrasound usually detects
heart rates by 10 weeks.
Cont……

• X-ray Examination: Fetal age can only be approximated

by x-ray evaluation of bony calcification. Fortunately, this
method has been largely replaced by the use of
ultrasound.

• Ultrasonography: Ultrasonography is now the most

widely used technique for determination of gestational
age.
Cont…..

• X-ray Examination: Fetal age can only be approximated

by x-ray evaluation of bony calcification. Fortunately,
this method has been largely replaced by the use of
ultrasound.

• Ultrasonography: Ultrasonography is now the most

widely used technique for determination of gestational
age.
Providing Focus Antenatal Care (FANC)
• Antenatal care is the care given to a woman during her
pregnancy from conception to the onset of true labour.
Basic Principles of Focused Antenatal Care
• Antenatal care service providers make a thorough evaluation

of the pregnant woman to identify and treat existing

obstetric and medical problems.

• Can have only four visits

 1st visit <16 Weeks

 2nd visits 24-28 Wks

 3rd visits 30-32 Wks

 4th visits 36-40 wks

Cont……
• They administer prophylaxis as indicated.

• With the mother, they decide on where to have the follow-

up antenatal visits, where to give birth and whom to be

involved in the pregnancy and postpartum care.

• Couples are aware of the possible pregnancy risks, so

pregnant women and their husbands are seen as ‘risk

identifiers’ after receiving counseling on danger symptoms.

Cont…..

The Basic and Specialized Components of FANC

• The FANC model divides pregnant women into two groups: those
eligible to receive routine antenatal care (called the basic
component), and those who need special care based on their
specific health conditions or risk factors (the specialized
component).
• A classifying checklist form contains 19 checklist questions that require
binary responses (yes/no). Women who answer ‘yes’ to any of the 19
questions would not be eligible for the basic component of the new
WHO antenatal care model; they should receive care corresponding to
the detected condition.
The Focus of ANC

The focus will be on:

Health promotion and diseases prevention
Early detection of complications arising during the
pregnancy
Birth preparedness/complication readiness
Identification of pre-existing health conditions
A. Health Promotion and Disease Prevention

1. Give iron and folic acid

• To all pregnant, postpartum and post abortion women:

Give routinely 60mg elemental iron and 400 μg folic acid
once daily in pregnancy and until 3 months after delivery
or abortion.

2. De-worming

• Give Mebendazol 500 mg once in second or third

trimester to every woman in hookworm endemic areas.
Cont…….
3. Immunization against tetanus
Dose Time of administration Duration of Protection
TT1 At first contact No protection
TT2 4weeks after TT1 Three years
TT3 At least 6 months after TT2 Five years
TT4 At least one year after TT3 Ten years
TT3 At least one year after TT4 Throughout her reproductive life (Thirty
years)

4. Routine HIV testing during pregnancy

• Provider initiated routine HIV testing and counseling
(HTC).
Cont…..
5. Prevention of malaria
• Use bed nets treated with insecticide, a mosquito-killing
chemical.
• In malaria-endemic areas pregnant women should be
given intermittent malaria prophylaxis.
6. Providing Iodine
• Lack of iodine in a pregnant woman can cause her child to
have cretinism. The easiest way to get enough iodine is to
use iodized salt.
B. Early Detection and Treatment of Complications and

Existing Diseases

• The provider talks with the woman and examines her for

pre-existing health conditions that may affect the

outcome of pregnancy, require immediate treatment or

require a more intensive level of monitoring and follow-

up care over the course of pregnancy.

C. Developing a Birth Plan and Complication Readiness

• Birth preparedness is the process of planning for a normal birth.

• Complication readiness is anticipating the actions needed in case

of an emergency.

 A skilled attendant at birth

 Place of birth and how to get there (emergency transportation)

 Items needed for the birth

 Money saved and Potential blood donors in case of emergency

 Support person during and after the birth (e.g., family, friends)
Objectives and Procedures at Each FANC Visit

• Sometimes a pregnant woman comes for the first

antenatal check-up when the pregnancy is already

advanced, but you should cover all activities even if

she is already in the second or third trimester.

Cont…….

The First FANC Visit

• The first FANC visit should ideally occur before 16 weeks of

pregnancy.

• Determine the woman’s medical and obstetric history in

order to collect evidence of her eligibility to follow the

basic component or determine if she needs special care.

• Perform basic examinations (PR, BP, RR, To, pallor).

Cont……

The Second FANC Visit

 Schedule the second FANC visit at 24-28 weeks of pregnancy.

 Follow the procedures already described for the first visit, In

addition:

• Address any complaints and concerns of the pregnant woman and

her partner.

• For first time mothers and anyone with a history of hypertension

or pre-eclampsia/eclampsia, perform the dipstick test for protein

in the urine.
Cont……
The Third FANC Visit

• The third FANC visit should take place around 30–32 weeks of

gestation.

• Direct special attention toward signs of multiple pregnancies

• Review the birth preparedness and complication readiness plan

• Perform the dipstick test for protein in the urine for all pregnant

women

• Give advice on family planning and exclusive breastfeeding for her

baby
Cont……
The Fourth FANC Visit
• The fourth FANC visit should be occur between 36-40
weeks of gestation.
• The abdominal examination should confirm fetal lie and
presentation
• Birth preparedness, complication readiness and
emergency planning should be reviewed.
• Advice the woman on signs of normal labour and
pregnancy related emergencies.
 Assessments of a Pregnant Woman
History Taking In Pregnant Women

1. Identification

• Name of the mother

• Age- < 20 years and > 35 years are risk

• Marital status – unplanned, unwanted and unsupported.

• Address- far distance from health institution

• Religion

• Occupation
Cont......

2. Chief Complaint

• Can be written in duration usually not more than two

complaints

3. History of Present Pregnancy

• Gravidity, Parity, EDD and Calculate gestational age

• Others conditions included under history of present

pregnancy are

• Quickening, ANC follow up or not, TT vaccine or not?

Cont.....

4. Past Obstetric History

• Place of birth, Length of gestation, Birth weight, Foetal outcome,

Duration of labour, Foetal presentation and Mode of delivery.

5. Gynaecology History

• History of abortion

• Contraception: Type duration and side effects.

• Gynaecology operations: FGM, MVA, laparatomy. ....etc.

• Any gynaecological disease, like STD, HIV/AIDS

• Menstrual history
Cont.....
6. Past Medical History
• Illnesses may have damaged which could give rise to
complications during labour. E.g. Polio, tuberculosis,
rickets (could cause pelvic deformity),
• Epilepsy, cardiac disease, DM, HTN...Etc cause labour
difficulties.
7. Past Surgical History
• Past operations has the mother had, e.g. blood
transfusion, caesarean section....etc.
Cont......
8. Personal and Social History
• Childhood development, educational status, living
environment, substance use & income.
9. Family History
• Family history is important because it provides
information about the health status of parents and
siblings hereditary or family disease.
Physical Examination
1. General Appearance
• Severity and acuteness of illness, posture emotional
state, facial expression and colour changes. General
appearance can be stated in well looking and sick looking.
2. Vital Sign
• B/P, Pulse, RR, To and weight.
Cont....

3. HEENT

• Head: Shape, size, masses, tenderness, Scars and cleanliness

of scalp.

• Ears: Mastoid tenderness, lesions of external ear, discharge.

• Eyes: Conjunctiva colour and sign of inflammation.

• Nose: Deformities, polyps and unusual discharge.

• Mouth and throat: Breath odour, lips, Gum, Tongue, Buccal

mucosa , tonsils
Cont…..
4. Lymph Glandular System (LGS)
• Lymphatic gland enlargement and tenderness.

• Thyroid gland

• Breast: Nipple everted or inverted and nipple discharges.

5. Respiratory System
• Inspect for cyanosis, character of respiration...Etc.

• Percussion for hyper resonant and dull...Etc.

• Auscultat character of breath sound...Etc.

Cont.....
6. Cardiovascular System (CVS)
• BP, PR, Abnormal venous distension over the neck
(jugular), S1 & S2 sound, systolic and diastolic murmurs
and gallop.
7. Abdominal Examination
1. Inspection
• Inspection of the 4’s (Shape, size, scar, skin).
Cont…….

Size of abdomen; observe whether it is too large or too small

Shape of abdomen

• Ovoid (oval) in primi gravida, Round in Multigravida

• Irregular in multiple pregnancies, Pendulous indicate none

engagement in primi after 36 weeks GA

Skin; observe for presence of striagravidarum and presence of

lineanigra.

Scars; observe any operation scars like, C/S, laparatomy and pelvic

surgery
Cont.....

2. Palpation (Obstetric palpation or Leopold’s manoeuvre)

1st Manoeuvre or fundal palpation and height

Fundal height measurement:

 Finger method

 Tape measurement tape (McDonald’s technique)

Fundal palpation:

 Use 2 hands using palms of hands palpate on either side of the

fundus and feel that as it is hard or soft or irregular.

 Soft irregular bulky mass is breech, when hard round ballotable mass

is Head
Cont....
2nd Manoeuvre or lateral palpation
• Fix the hand on the center of the abdomen, fix the right hand
and palpate with left hand and vise versa. The regular, linear,
rigid and smooth side is the back, FHB well heard on back side
3rd Manoeuvre or pelvic palpation
• Feel presenting part, is it hard or soft.

4th Manoeuvre or pawliks grip

• The lower pole of the uterus is grasped with the right hand by
facing the women's head, feel which is lower.
Cont......
3. Auscultation
• FHB first heard in the back side 16-18 weeks in
multiparas and 18-20 weeks in primigravida.
• Above umbilicus FHB well heard in breech below
umbilicus in cephalic and at flank in OPP, midway in face
presentation.
Cont.....
8. Genito Urinary System (GUS)
• Detect cost vertebral angle tenderness (CVAT) and
suprapubic tenderness.
• Perform pelvic examination, Assess external genitalia for
any abnormalities.
9. Intgumentary System
• Skin texture: dry or moist, temperature, rashes, ulcers,
observes sign of inflammation.
Cont.....
10. Extremities
• Check for oedema, dilated vessels, calf tenderness and
deformity.
11. Central Nervous System (CNS)
• Mental status, orientation in person, place and time level
of consciousness and speech.
12. Assessment
• The final clinical impression which is reached according to
the above systematic discussion.
Cont.....
13. Plan

Under take routine/basic

Optional laboratory
laboratory investigation
• Blood Group and Rh factor investigations
• Hemtocrite • FBS/RBS
• VDRL
• Sputum test
• Hepatitis B and Hepatitis C

• Urine analysis
• Stool

• HIV counselling and testing examination...etc.

The Relationships between the Maternal Pelvis and Uterus
to the Fetus
1. Lie
• Is the relationship of the long axis of the fetus to the long
axis of the maternal uterus. It may be longitudinal
(99%) , oblique or transverse (both are 1%).
Cont.....

2. Presentation

• Is the part of the fetus which lies at the pelvic brim or in the
lower pole of the uterus, these are:

 The vertex- about - 96.8%

 The breech – about - 2.5%

 The shoulder – about - 0.4%

 The face – about - 0.2 %

 The brow – about - 0.1%

• Vertex, face and brow are all head or cephalic presentations.

Cont....

3. Attitude

• The relationship of the fetal head and limbs to its trunk

• Flexed attitude: - Cephalic prominence feel in opposite side

of the back e.g. Vertex.

• Extended attitude: - Cephalic prominence on side of the

back. E.g. face presentation.

• Midway (military attitude):- The fetal head is neither flexed

nor extended and cephalic prominence on both side at the

same level e.g. Brow presentation.
Cont......
4. Denominator
• The part of the presentation that indicates or determines the
position of the fetus
• The denominator in vertex presentation is occiput

• The denominator in breech presentation is sacrum

• The denominator in face presentation is mentum

• The denominator in shoulder presentation is acromion

process
• The denominator in brow presentation is sinciput.
Cont.....

5. Position

• Position is the relationship between the denominator of the

presentation and eight points on the pelvic brim. Eighth areas of the
pelvic brim are:

• Right posterior (RP): When the denominator point at the right

sacroiliac joint.

• Right lateral (RL): When the denominator points midway between

the right sacroiliac joint and the right iliopectineal eminence.

• Right anterior (RA): When the denominator points at the right

iliopectineal eminence.
Cont......

• Left posterior (LP): When the denominator points at the left

sacroiliac joint.

• Left lateral (LL): When nth denominator points midway between

the left sacroiliac joint and the left iliopectineal eminence.

• Left anterior (LA): When the denominator points at the left

iliopectineal eminence.

• Direct anterior (DA): When the denominator points at the centre of

symphysis.

• Direct posterior (DP): When the denominator points at the centre

of promontory of the sacrum.
Cont.....

6. Presenting Part

• The part which lies over the cervical OS during labour,

It can be cord, placenta, hand, ear, scrotum and leg.

7. Crowning

• The term used when the occipital prominence of the

head escapes under the symphysis pubis and the
head no longer recedes between contractions.
Cont....

8. Engagement

• Engagement is when the widest presenting transverse diameter

(biparietal) has passed through the brim of the pelvis.

 5/5 when the whole head can be palpated over the pelvis.

 4/5 one fifth is below the pelvic brim.

 3/5 two fifths are under the pelvic brim.

 2/5 three fifths are under the pelvic brim.

 1/5 four fifths are under the pelvic brim.

 0/5 five fifths are under the pelvic brim.

Cont.....
8. Station
• The relationship between presenting fetal part in the
birth canal is described in to the ischial spines.
• -3 station when the presenting part presents 3cm above
ischial spine.
• -2 stations when the presenting part presents 2cm above
ischial spine.
• -1 station when the presenting part presents 1cm above
ischial spine.
Cont......
• 0 station when the presenting part presents at the level
of ischial spines
• + 1 station when the presenting part presents 1 cm
below the ischial spines
• + 2 station when the presenting part presents 2 cm
below the ischial spines
• When the presenting part is visible at the introits it is
said to be at the + 3 station
Types of Minor Disorders of Pregnancy
1. Nausea and Vomiting
• Nausea and vomiting presents usually between 4 and
16 weeks of gestation.
Management
• Mothers often find light snacks more tolerable than
full meals.
• Carbohydrate snacks before rising and at bedtime can
help prevent hypoglycemia
Cont……

2. Heartburn or Gastric Esophageal Reflux Disease (GERDS)

• Is a burning sensation in the mediastinal region and Occur at about

30-40 wks gestation

Management

• Keep her stomach less full by eating smaller meal

• Avoid eating spicy or greasy foods

• Regularly eat papaya (pineapple)

• Keep her head higher than her stomach when lying or sleeping.

• Calm the acids in the stomach by drinking milk, For persistent

heartburn antacids may be prescribed.

Cont……

3. Pica (A Food Craving or cissa)

• Strong desire to eat a certain food or even something that is not

food at all, like soil, chalk, advised they may poison her and her baby.

• Encourage her to eat iron-rich and calcium-rich foods instead.

4. Ptyalism (Sialorrhoea)

• Increased salivation may occur early in pregnancy and subsides later

on.

• Advice on dental hygiene and to discontinue smoking

• Anticholinergic drugs as belladonna, which induce dryness of the

mouth
Cont….
5. Constipation
• Some pregnant women have difficulty in passing stools.

Management
• Eat more fruits and vegetables

• Eat whole grains

• Drink at least eight cups of clean water a day

• Exercise every day

• Try home or plant-based remedies that will soften the stool

Cont……

6. Hemorrhoids (Piles)

• Hemorrhoids are swollen veins around the anus.

Management

• Avoid getting constipated by eating a lot of fruit and

vegetables and drinking plenty of fluids.

• Sitting in a cool bath or lying down can help.

Cont…….

7. Backache

• The weight of the baby, the uterus and the amniotic fluid,

changes her posture and puts a strain on the woman’s

bones and muscles.

Management

• Encourage family members or friends to massage the

woman’s back.

• Avoid doing some of the heavy work.

Cont……
8. Frequency of Micturation

• Occurs early weeks of pregnancy when the growing uterus

is still situated in the pelvis, at the end of the pregnancy
the problem may due to the engagement of the head.

9. Leucorrhea

• This is the term used for the increased white, non-irritant

vaginal discharge.

• Advice on washing with plain water two times a day

• Wear underwear of cotton and avoid tights.

Cont……
10. Fainting
• In early pregnancy fainting may be due to the
vasodilatation
• In later pregnancy when she lies on her back
compression of the inferior vena cava happen and slows
the return of blood to the heart (supine hypotensive
syndrome)
• Avoiding long periods standing is helpful advice.
Cont……
11. Varicosities
• Progesterone relaxes the smooth muscles of the veins
and results in sluggish circulations.
• Varicose veins may occur in the legs, anus and vulva-in
any area of increased venous pressure.
• Exercising the calf muscles by rising onto the toes or
making circular movements with the ankles will help the
venous return.
Cont……
12. Carpal Tunnel Syndrome
• Feeling of numbness in fingers and hands.

• It is caused by fluid retention which creates edema and

pressure on the median nerve.
• The treatment is to rest the hand high on some pillows
during the night.
• Sometimes the condition resolved by giving pyridoxine
(vitamin B6).
Cont…..
13. Insomnia
• There are physical reasons for sleep disturbance such as
nocturnal frequency and difficulties in getting
comfortable
• Advice on increased anxieties

14. Abdominal Cramps in Early Pregnancy

• It is normal to have mild abdominal cramps at times
during the 1st trimester of pregnancy.
• These cramps happen because the uterus is growing.
Cont…….
15. Headaches and Migraines
• Headaches are common in pregnancy, but are usually
harmless. However, headaches late in pregnancy may be a
warning sign of pre-eclampsia
Management
• Migraine medicine is very dangerous in pregnancy.
• Rests and relaxes more, drinks more juice or gently
massages her temples
• It is better to take 500 to 1,000 mg of paracetamol
Cont…….
16. Oedema
• Swelling of the feet and ankles is very common in
pregnancy, especially in hot weather.
Management
• Swelling in the feet may improve if the woman puts her
feet up for a few minutes at least two or three times a
day, avoids eating packaged foods that are very salty.
Cont…..

17. Dyspnea (Shortness of Breath)

• Many women get short of breath they are pregnant,
Breathlessness is because of the growing baby crowds the
mother’s lungs and she has less room to breathe.

Management
• Reassure women who are breathless near the end of
pregnancy that is normal.
• But if a woman is also weak and tired, or if she is short of
breathe all of the time, she should be checked.