1. WONDERS OFWONDERS OF
FERTILIZATIOFERTILIZATIO
NN
STAGES OF FETALSTAGES OF FETAL
GROWTH ANDGROWTH AND
DEVELOPMENTDEVELOPMENT

3. FERTILIZATIONFERTILIZATION
 Other terms: CONCEPTION,Other terms: CONCEPTION,
IMPREGNATION, ORIMPREGNATION, OR
FECUNDATION.FECUNDATION.
 THE UNION OF SPERM CELL ORTHE UNION OF SPERM CELL OR
SPERMATOZOON AND EGG CELLSPERMATOZOON AND EGG CELL
OR OVUMOR OVUM
 Occurs in the outer third of theOccurs in the outer third of the
fallopian tubefallopian tube
 Fertilization may occur in about 72Fertilization may occur in about 72
hourshours

4.  After ovulation the ovum is releasedAfter ovulation the ovum is released
from the graafian folliclefrom the graafian follicle
 The ovum is surrounded by ZONAThe ovum is surrounded by ZONA
PELLUCIDA a ring ofPELLUCIDA a ring of
mucopolysaccharide fluid and a circlemucopolysaccharide fluid and a circle
of cells the CORONA RADIATA.of cells the CORONA RADIATA.
 These increase the bulk of the ovumThese increase the bulk of the ovum
thus facilitates the migration to thethus facilitates the migration to the
uterusuterus
 Peristaltic action of the tube andPeristaltic action of the tube and
movement of the tube cilia helpmovement of the tube cilia help
propel the ovum along the length ofpropel the ovum along the length of
the tube.the tube.

5.  Only one ovum reaches maturityOnly one ovum reaches maturity
each montheach month
 Once released fertilization mustOnce released fertilization must
occur quickly because an ovum isoccur quickly because an ovum is
capable of fertilization for only 24capable of fertilization for only 24
hours (48 hours the most)hours (48 hours the most)
 If not fertilized it atrophies andIf not fertilized it atrophies and
becomes non functionalbecomes non functional
 Normally an ejaculation of semenNormally an ejaculation of semen
averages 2.5 ml of fluid containingaverages 2.5 ml of fluid containing
50 – 200 million spermatozoa per50 – 200 million spermatozoa per
milliliter, or an average of 400 millionmilliliter, or an average of 400 million
per ejaculationsper ejaculations
 3 -5 cc or 1 teaspoon – normal3 -5 cc or 1 teaspoon – normal
amount of spermamount of sperm

6.  At the time of ovulation there isAt the time of ovulation there is
a reduction of cervical mucusa reduction of cervical mucus
viscosity, making it as an easyviscosity, making it as an easy
access for spermatozoonaccess for spermatozoon
penetrationpenetration
 Spermatozoa deposited in theSpermatozoa deposited in the
vagina during intercoursevagina during intercourse
generally reach the cervixgenerally reach the cervix
within 80 seconds and thewithin 80 seconds and the
outer end of fallopian tubeouter end of fallopian tube
within 5 minutes.within 5 minutes.
 Sperm: pearly white, smallSperm: pearly white, small
head, long tail or flagellahead, long tail or flagella

7.  Phonus – vibration of the head ofPhonus – vibration of the head of
the sperm and determines thethe sperm and determines the
location of the ovumlocation of the ovum
 CAPACITATION – ability of theCAPACITATION – ability of the
sperm to release proteolyticsperm to release proteolytic
enzymes and penetrates coronaenzymes and penetrates corona
radiataradiata
 This process, which happens as theThis process, which happens as the
sperm move toward the ovum,sperm move toward the ovum,
consist of plasma changes in theconsist of plasma changes in the
sperm head which reveals thesperm head which reveals the
sperm binding receptor sitessperm binding receptor sites
 Only one spermatozoon is able toOnly one spermatozoon is able to
penetrate the cell membrane of thepenetrate the cell membrane of the
ovumovum

8.  Once it penetrates the zonaOnce it penetrates the zona
pelucida, the cell membranepelucida, the cell membrane
becomes impervious to otherbecomes impervious to other
spermatozoa.spermatozoa.
 After penetration of the ovum theAfter penetration of the ovum the
chromosomal material of thechromosomal material of the
ovum and spermatozoon fuse.ovum and spermatozoon fuse.
They are now called the ZYGOTEThey are now called the ZYGOTE
 A fertilized ovum has 46A fertilized ovum has 46
chromosomeschromosomes
 Spermatozoon and ovum eachSpermatozoon and ovum each
carried 23 chromosomes (22carried 23 chromosomes (22
autosomes and 1 sexautosomes and 1 sex
chromosomes)chromosomes)

10.  Fertilization depends on 3Fertilization depends on 3
factorsfactors::
 Maturation of both sperm andMaturation of both sperm and
ovumovum
 The ability of the sperm toThe ability of the sperm to
reach the ovumreach the ovum
 The ability of the sperm toThe ability of the sperm to
penetrate the zona pellucidapenetrate the zona pellucida
and the cell membrane andand the cell membrane and
achieve fertilizationachieve fertilization

11. IMPLANTATIONIMPLANTATION
 It takes 3 or 4 days for the zygote to reach theIt takes 3 or 4 days for the zygote to reach the
body of the uterusbody of the uterus
 During this time, mitotic cell division orDuring this time, mitotic cell division or
cleavage, begins.cleavage, begins.
 The first cleavage occurs at about 24 hoursThe first cleavage occurs at about 24 hours
 PRE EMBRYONIC STAGE: By the time thePRE EMBRYONIC STAGE: By the time the
fertilized cell reaches the body of the uterus, itfertilized cell reaches the body of the uterus, it
consist of 16 to 50 cells.consist of 16 to 50 cells.
 Because of its bumpy outward appearance it isBecause of its bumpy outward appearance it is
termed a morula (mullberry)termed a morula (mullberry)

13.  Morula continues to multiply as itMorula continues to multiply as it
floats free in the uterine cavity forfloats free in the uterine cavity for
3 or 4 more days3 or 4 more days
 Blastocyst – enlarging cellBlastocyst – enlarging cell
forming a cavity that becomes anforming a cavity that becomes an
embryo. These structuresembryo. These structures
attaches to the uterineattaches to the uterine
endometrium.endometrium.
 Thropoblast – covering ofThropoblast – covering of
blastocyst that become placentablastocyst that become placenta
and membranesand membranes
 The inner cell mass (embryoblastThe inner cell mass (embryoblast
cells) is the portion that will latercells) is the portion that will later
form the embryo.form the embryo.

14. Implantation/ NidationImplantation/ Nidation
 Occurs 8 to 10 days after fertilizationOccurs 8 to 10 days after fertilization
 3 Process of implantation3 Process of implantation
 Apposition – Blastocyst begin to brushApposition – Blastocyst begin to brush
endometriumendometrium
 Adhesion – Blastocyst begin to attach toAdhesion – Blastocyst begin to attach to
endometriumendometrium
 Invasion – Blastocyst begins to settle down intoInvasion – Blastocyst begins to settle down into
the soft folds of endometrium.the soft folds of endometrium.

15.  The trophoblast cell outside theThe trophoblast cell outside the
blastocyst structure touch theblastocyst structure touch the
endometrium, they produceendometrium, they produce
proteolytic enzyme that dissolve theproteolytic enzyme that dissolve the
tissue they touch.tissue they touch.
 This action allows the blastocyst toThis action allows the blastocyst to
burrow deeply into the endometriumburrow deeply into the endometrium
and receive some basicand receive some basic
nourishment of glycogen andnourishment of glycogen and
mucoprotein from the endometrialmucoprotein from the endometrial
glandgland
 Effective communication networkEffective communication network
with the blood system of thewith the blood system of the
endometrium is establishedendometrium is established

16. Embryonic and FetalEmbryonic and Fetal
StructureStructure
 DECIDUADECIDUA
 After fertilization, corpus luteum in the ovaryAfter fertilization, corpus luteum in the ovary
continues to function rather than to atrophycontinues to function rather than to atrophy
because of HCG secreted by trophoblastbecause of HCG secreted by trophoblast
cellscells
 Thus the endometrium continues to grow inThus the endometrium continues to grow in
thickness and vascularitythickness and vascularity
 The endometrium is now termed DECIDUAThe endometrium is now termed DECIDUA

17. 3 separate area of3 separate area of
Decidua:Decidua:
 Decidua BasalisDecidua Basalis – the part of the– the part of the
endometrium lying directly under the embryoendometrium lying directly under the embryo
( the portion where the trophoblast cells are( the portion where the trophoblast cells are
establishing communication with maternalestablishing communication with maternal
blood vessels)blood vessels)
 Decidua CapsularisDecidua Capsularis – The portion of the– The portion of the
endometrium that stretches or encapsulatesendometrium that stretches or encapsulates
the surface of the trophoblastthe surface of the trophoblast
 Decidua VeraDecidua Vera – Remaining portion of the– Remaining portion of the
endometriumendometrium

19. CHORIONIC VILLICHORIONIC VILLI
 As early as 11As early as 11thth
or 12or 12thth
day miniature villi,day miniature villi,
or probing “fingers” termed chorionic villi,or probing “fingers” termed chorionic villi,
reach out from the single layer of cellsreach out from the single layer of cells
into the uterine endometrium.into the uterine endometrium.
 At term, nearly 200 such villi will haveAt term, nearly 200 such villi will have
formedformed

20. Chorionic VilliChorionic Villi
SamplingSampling Removal of tissue sample from the fetalRemoval of tissue sample from the fetal
portion of the developing placentaportion of the developing placenta
 Purpose – to determine the presence ofPurpose – to determine the presence of
genetic abnormalities; a transabdominal orgenetic abnormalities; a transabdominal or
transcervical approach may be used.transcervical approach may be used.
Genetic screening.Genetic screening.
 Indications – as for amniocentesis but CVSIndications – as for amniocentesis but CVS
can be performed earlier (9 to 12 weekscan be performed earlier (9 to 12 weeks
gestation) and results obtained sooner (1 togestation) and results obtained sooner (1 to
2 weeks)2 weeks)

21.  Complication rate is slightly higher thanComplication rate is slightly higher than
for amniocentesis primarily related tofor amniocentesis primarily related to
bleeding spontaneous abortion, rupturebleeding spontaneous abortion, rupture
of membranes, infection, preterm birthof membranes, infection, preterm birth
fetal limb defects such as missing fingersfetal limb defects such as missing fingers
of toes.of toes.
 Protocol: Invasive procedure: neededProtocol: Invasive procedure: needed
consent and full bladderconsent and full bladder
 Ultrasound – used throughout to guide theUltrasound – used throughout to guide the
procedureprocedure
 Client preparation – similar to that of anClient preparation – similar to that of an
amniocentesis except full bladder may beamniocentesis except full bladder may be
needed to position the uterus for easierneeded to position the uterus for easier
catheter insertioncatheter insertion

22.  Position depends on approach –Position depends on approach –
transabdominal (supine) or transcervicaltransabdominal (supine) or transcervical
(lithotomy)(lithotomy)
 Vital signs are monitoredVital signs are monitored
 Care after the procdure and dischargeCare after the procdure and discharge
instructions are similar to those for aninstructions are similar to those for an
amniocentesisamniocentesis

23. Outline of TrophoblastOutline of Trophoblast
DifferentiationDifferentiation
 CYTOTHROPOBLAST or Langhan’sCYTOTHROPOBLAST or Langhan’s
layer – present as early as 12 dayslayer – present as early as 12 days
gestation.gestation.
 Protects the growing embryo and fetus fromProtects the growing embryo and fetus from
certain infectious organisms such as thecertain infectious organisms such as the
spirochete of syphilis.spirochete of syphilis.
 This layer disappears between the 20This layer disappears between the 20thth
andand
2424thth
week.week.

25. SYNCTIOTROPHOBLASSYNCTIOTROPHOBLAS
T or Syncytial layerT or Syncytial layer
 The outer layer containing fingerlikeThe outer layer containing fingerlike
projections called chorionic villiprojections called chorionic villi
 Gives rise to the fetal membranes:Gives rise to the fetal membranes:
1.AMNION – inner membrane which gives1.AMNION – inner membrane which gives
rise torise to
 UMBILICAL CORD/FUNIS – contains 2UMBILICAL CORD/FUNIS – contains 2
Arteries and 1 Vein, which is supported byArteries and 1 Vein, which is supported by
Wharton’s JellyWharton’s Jelly

27.  AMNIOTIC FLUIDAMNIOTIC FLUID
 Clear albuminous fluid in which the babyClear albuminous fluid in which the baby
floatsfloats
 Begins to form at 11 – 15 weeks gestationBegins to form at 11 – 15 weeks gestation
 Approximates water in specific gravity (1.007Approximates water in specific gravity (1.007
– 1.025) and is neutral to slightly alkaline– 1.025) and is neutral to slightly alkaline
 Near term is clear, colorless, containing littleNear term is clear, colorless, containing little
white specks of vernix caseosa and otherwhite specks of vernix caseosa and other
solid particlessolid particles
 Produced at a rate of 500 ml in 24 hours andProduced at a rate of 500 ml in 24 hours and
fetus swallows it at an equally rapid rate. Byfetus swallows it at an equally rapid rate. By
the 4the 4thth
lunar month urine is added to thelunar month urine is added to the
amount of amniotic fluid.amount of amniotic fluid.

29.  Amniotic fluid therefore, is derived chieflyAmniotic fluid therefore, is derived chiefly
from maternal serum and fetal urinefrom maternal serum and fetal urine
 Implications: a case ofImplications: a case of
POLYHYDRAMNIOS (>1500ml ofPOLYHYDRAMNIOS (>1500ml of
amniotic fluid) stems from inability of theamniotic fluid) stems from inability of the
fetus to swallow amniotic fluid rapidly asfetus to swallow amniotic fluid rapidly as
in tracheoesophageal fistula.in tracheoesophageal fistula.
 OLIGOHYDRAMNIOS (<500 ml ofOLIGOHYDRAMNIOS (<500 ml of
amniotic fluid, is due to inability of theamniotic fluid, is due to inability of the
kidneys to add urine to the amniotic fluid,kidneys to add urine to the amniotic fluid,
as in Congenital renal Anomalyas in Congenital renal Anomaly

31.  Also known as Bag of WaterAlso known as Bag of Water
(BOW), it serves the following(BOW), it serves the following
purpose:purpose:
 Protection – shields the fetusProtection – shields the fetus
against blows or pressures on theagainst blows or pressures on the
mothers abdomen, againstmothers abdomen, against
sudden changes in temperaturesudden changes in temperature
and from infectionsand from infections
 Diagnosis – as in amniocentesis;Diagnosis – as in amniocentesis;
meconium stained amniotic fluidmeconium stained amniotic fluid
means fetal distressmeans fetal distress
 Aids in the descent of fetus duringAids in the descent of fetus during
active laboractive labor

32.  Diagnostic test for Amniotic FluidDiagnostic test for Amniotic Fluid
 AMNIOCENTESISAMNIOCENTESIS
 Purpose: obtain a sample of amniotic fluidPurpose: obtain a sample of amniotic fluid
by inserting a needle through the abdomenby inserting a needle through the abdomen
into the amniotic sac; fluid is tested forinto the amniotic sac; fluid is tested for
1.1. Genetic screeningGenetic screening
Early testing time – 9 – 12 weeks with resultsEarly testing time – 9 – 12 weeks with results
available in 10 to 14 daysavailable in 10 to 14 days
Traditional Testing time – 14Traditional Testing time – 14thth
to 16to 16thth
week withweek with
results availableresults available
Performed to determine presence of such problemPerformed to determine presence of such problem
as Down syndrome, Neural Tube Defect,as Down syndrome, Neural Tube Defect,
Inborn errors of metabolismInborn errors of metabolism

35. 2. Determination of fetal maturity primarily2. Determination of fetal maturity primarily
by evaluating factors indicative of lungby evaluating factors indicative of lung
maturitymaturity
Testing time – During 3Testing time – During 3rdrd
trimester aroundtrimester around
3636thth
when lung maturation have occurredwhen lung maturation have occurred
Factors – both should be present @Factors – both should be present @
approximately 36 wks AOGapproximately 36 wks AOG
1. L/S ratio (lecithin/ sphingomyelin)1. L/S ratio (lecithin/ sphingomyelin)
greater than 2;1greater than 2;1
2. Presence of phosphatidyglycerol (PG)2. Presence of phosphatidyglycerol (PG)
termed PG+ (definite test for fetal lungtermed PG+ (definite test for fetal lung
maturity)maturity)

36.  Indications:Indications:
 Family HistoryFamily History
 Women of advance age, >35 years of ageWomen of advance age, >35 years of age
 Assurance of lung maturity prior to inducingAssurance of lung maturity prior to inducing
labor or performing an elective cesareanlabor or performing an elective cesarean
sectionsection
Overall complication rate is 1 %:Overall complication rate is 1 %:
Most common complication: Infection,Most common complication: Infection,
Spontaneous abortion, Preterm laborSpontaneous abortion, Preterm labor
Position: Transvaginal = LithotomyPosition: Transvaginal = Lithotomy
Trans abdominal = SupineTrans abdominal = Supine
Protocol: empty the bladderProtocol: empty the bladder

37. a.a. Ultrasound – identify placental and fetalUltrasound – identify placental and fetal
location to avoid damage and pinpointlocation to avoid damage and pinpoint
amniotic fluid pocketsamniotic fluid pockets
b.b. PreparationPreparation
a.a. Provide emotional support and assistanceProvide emotional support and assistance
with relaxation techniques since womanwith relaxation techniques since woman
may be restless and frightenedmay be restless and frightened
b.b. Verify informed consent forms areVerify informed consent forms are
completecomplete
c.c. Assist woman to empty bladderAssist woman to empty bladder
d.d. Position: supine, be alert for supinePosition: supine, be alert for supine
hypotensive syndrome during and after thehypotensive syndrome during and after the
test.test.

38.  Greenish Amniotic Fluid – ExperienceGreenish Amniotic Fluid – Experience
Hypoxia, common in post term babyHypoxia, common in post term baby
 Yellowish Amniotic Fluid – Jaundice orYellowish Amniotic Fluid – Jaundice or
hyperbilirubinemiahyperbilirubinemia
 Cloudy Amniotic fluid – InfectionCloudy Amniotic fluid – Infection
 Shake test or Foam test:Shake test or Foam test:
 Stable Bubbles – 2:1 L/S ratioStable Bubbles – 2:1 L/S ratio
 Bubbles evaporates – 1:2 L/S ratio/Bubbles evaporates – 1:2 L/S ratio/
Respiratory Distress SyndromeRespiratory Distress Syndrome

39. 2. CHORION2. CHORION
 Together with the decidua basalis, givesTogether with the decidua basalis, gives
rise to the placenta, which starts to formrise to the placenta, which starts to form
at 8at 8thth
week gestation. Develop into 15 –week gestation. Develop into 15 –
20 subdivisions called COTYLEDONS.20 subdivisions called COTYLEDONS.
 Placenta serves the following purpose:Placenta serves the following purpose:
 Respiratory System – exchange of gasesRespiratory System – exchange of gases
takes place in the placenta not in the fetaltakes place in the placenta not in the fetal
lungslungs
 Renal System – waste products are beingRenal System – waste products are being
excreted through the placenta( Note: it is theexcreted through the placenta( Note: it is the
mothers liver that detoxifies fetal wastemothers liver that detoxifies fetal waste
products)products)

41.  Gastrointestinal System – Nutrients passGastrointestinal System – Nutrients pass
to the fetus via the placenta by diffusionto the fetus via the placenta by diffusion
through the placental tissuesthrough the placental tissues
 Circulatory System – feto-placentalCirculatory System – feto-placental
circulation is established by selectivecirculation is established by selective
osmosis through the chorionic villi. Aboutosmosis through the chorionic villi. About
100 maternal uterine artery supply the100 maternal uterine artery supply the
mature placenta.mature placenta.
 To provide enough blood for exchange, theTo provide enough blood for exchange, the
rate of uteroplacental blood flow torate of uteroplacental blood flow to
pregnancy increases from about 50ml/min atpregnancy increases from about 50ml/min at
10 weeks to 500 – 600 ml/min at term10 weeks to 500 – 600 ml/min at term

42.  At term, the placental circulatory network is soAt term, the placental circulatory network is so
extensive that a placenta weighs 400 – 600extensive that a placenta weighs 400 – 600
grams and is 1 sixth the weight of the baby.grams and is 1 sixth the weight of the baby.
 Endocrine system – it produces the followingEndocrine system – it produces the following
important hormonesimportant hormones
 Human Chorionic Gonadotrophin – orders theHuman Chorionic Gonadotrophin – orders the
corpus luteum to keep on producing estrogen andcorpus luteum to keep on producing estrogen and
progesterone, that is why menstruation does notprogesterone, that is why menstruation does not
occur during pregnancy.occur during pregnancy.
 At about 8 weeks of pregnancy, the outerAt about 8 weeks of pregnancy, the outer
layer of cell of developing placenta beginslayer of cell of developing placenta begins
to produce progesterone.to produce progesterone.

43.  ESTROGEN – (Estriol) contributes to theESTROGEN – (Estriol) contributes to the
mother’s mammary gland development inmother’s mammary gland development in
preparation for lactation and stimulatespreparation for lactation and stimulates
uterine growth to accommodate theuterine growth to accommodate the
developing fetusdeveloping fetus
 PROGESTERONE – maintain thePROGESTERONE – maintain the
endometrial lining of the uterus duringendometrial lining of the uterus during
pregnancy. Reduce the contractility ofpregnancy. Reduce the contractility of
the uterine musculature duringthe uterine musculature during
pregnancy, which prevents prematurepregnancy, which prevents premature
laborlabor

44.  HUMAN PLACENTALHUMAN PLACENTAL
LACTOGEN(HUMAN CHORIONICLACTOGEN(HUMAN CHORIONIC
SOMATOMAMMOTROPIN) – promotesSOMATOMAMMOTROPIN) – promotes
growth of mammary glands necessary forgrowth of mammary glands necessary for
lactation. Also has growth stimulatinglactation. Also has growth stimulating
propertiesproperties

45. Origin andOrigin and
Development of OrganDevelopment of Organ
SystemSystem
 PRIMARY Germ layer – at the time ofPRIMARY Germ layer – at the time of
implantation, the blastocyst alreadt hasimplantation, the blastocyst alreadt has
differentiated to a point at which twodifferentiated to a point at which two
separate cavities appear in the innerseparate cavities appear in the inner
structure:structure:
 A large one the amniotic cavity, which isA large one the amniotic cavity, which is
lined with ECTODERMlined with ECTODERM

46.  A smaller cavity, the yolk sac,A smaller cavity, the yolk sac,
which is lined withwhich is lined with
ENTODERM cellsENTODERM cells
 Between the amniotic cavityBetween the amniotic cavity
and the yolk sac, a third layerand the yolk sac, a third layer
of primary cells, theof primary cells, the
MESODERM forms.MESODERM forms.
 The embryo will begin toThe embryo will begin to
develop at the point wheredevelop at the point where
the three cell layers meetthe three cell layers meet

47. ECTODERMECTODERM
 Central Nervous SystemCentral Nervous System
 Peripheral Nervous systemPeripheral Nervous system
 Skin, hair and nailsSkin, hair and nails
 Sebaceous glandsSebaceous glands
 Sense organsSense organs
 Mucous membranes of the anus,Mucous membranes of the anus,
mouth and nosemouth and nose
 Tooth enamel and MammaryTooth enamel and Mammary
glandsglands

48. MESODERMMESODERM
 Connective tissues,Connective tissues,
bones, cartilage, muscle,bones, cartilage, muscle,
ligaments and tendonsligaments and tendons
 Dentin of teethDentin of teeth
 Kidneys and uretersKidneys and ureters
 Reproductive systemReproductive system
 HeartHeart
 Circulatory SystemCirculatory System
 Blood cells and LymphBlood cells and Lymph
vesselsvessels

49. ENTODERMENTODERM
 Lining of pericardial,Lining of pericardial,
pleura, and peritonealpleura, and peritoneal
cavitiescavities
 Lining of theLining of the
Gastrointestinal tractGastrointestinal tract
 Respiratory tract, tonsils,Respiratory tract, tonsils,
parathyroid, thyroid,parathyroid, thyroid,
thymus glandsthymus glands
 Bladder and UrethraBladder and Urethra

50.  All organ systems are complete, atleastAll organ systems are complete, atleast
in a rudimentary form, at 8 weeksin a rudimentary form, at 8 weeks
gestation. During this early time ofgestation. During this early time of
ORGANOGENESIS, the growingORGANOGENESIS, the growing
structure is vulnerable to invasion bystructure is vulnerable to invasion by
teratogens.teratogens.

51. TERATOGENSTERATOGENS
 Any drug, virus or irradiation, the exposure toAny drug, virus or irradiation, the exposure to
which may cause damage to the fetuswhich may cause damage to the fetus
 A. DRUGSA. DRUGS
 Streptomycin – ototoxic (poor hearing), CN 8Streptomycin – ototoxic (poor hearing), CN 8
affectedaffected
 Tetracycline – Staining of tooth enamel, InhibitsTetracycline – Staining of tooth enamel, Inhibits
growth of long bonesgrowth of long bones
 Iodides – Enlargement of thyroid or GoiterIodides – Enlargement of thyroid or Goiter
 Thalidomides – Phocomelia or ameliaThalidomides – Phocomelia or amelia
 Steroids – Cleft lip, cleft palate, abortionSteroids – Cleft lip, cleft palate, abortion
 Lithium – congenital malformationLithium – congenital malformation

52.  AlcoholAlcohol
 Low birth weightLow birth weight
 Fetal alcohol withdrawal symptomsFetal alcohol withdrawal symptoms
 VasoconstrictionsVasoconstrictions
SMOKINGSMOKING
CAFFEINECAFFEINE
Low birth weightLow birth weight

53. TORCH (teratogenic)TORCH (teratogenic)
InfectionsInfections
 Group of infections caused by organismsGroup of infections caused by organisms
that can cross the placenta or ascendthat can cross the placenta or ascend
through birth canal and adversely affectthrough birth canal and adversely affect
fetal growth and development.fetal growth and development.
 Often characterized by vague, influenzaOften characterized by vague, influenza
like findings, rashes and lesions,like findings, rashes and lesions,
enlarged lymph nodes, and jaundiceenlarged lymph nodes, and jaundice
 Devastating effect on the babyDevastating effect on the baby

54.  T – TOXOPLASMOSIS – a protozoanT – TOXOPLASMOSIS – a protozoan
infection transmitted by handling rawinfection transmitted by handling raw
meat, cat litter or soil contaminated withmeat, cat litter or soil contaminated with
cat feces, eating raw or inadequatelycat feces, eating raw or inadequately
prepared meat animal products andprepared meat animal products and
inadequately washed vegetables.inadequately washed vegetables.
 O – OthersO – Others
 HEPATITIS A – a viral infection transmittedHEPATITIS A – a viral infection transmitted
by droplets, hands contaminated by oralby droplets, hands contaminated by oral
fecal material while eating and eating foodfecal material while eating and eating food
handled by persons with contaminatedhandled by persons with contaminated
hands.hands.

55.  Hepatitis B (serum hepatitis) – a viralHepatitis B (serum hepatitis) – a viral
infection transmitted by contactinfection transmitted by contact
substances containing blood. Use of orsubstances containing blood. Use of or
injury by contaminated needles orinjury by contaminated needles or
syringes, sexual intercourse, handling ofsyringes, sexual intercourse, handling of
materials containing blood includingmaterials containing blood including
transfusions, dressings, drainage ortransfusions, dressings, drainage or
exposure during a splash or spray ofexposure during a splash or spray of
blood as may occur during birth, surgery.blood as may occur during birth, surgery.

56.  HUMAN IMMUNODEFICIENCY VIRUS – aHUMAN IMMUNODEFICIENCY VIRUS – a
retrovirus transmitted by contact withretrovirus transmitted by contact with
contaminated body fluids including blood andcontaminated body fluids including blood and
semen; infected pregnant women can infectsemen; infected pregnant women can infect
fetus – newborn transplacentally, contact withfetus – newborn transplacentally, contact with
maternal blood, body fluids during labor andmaternal blood, body fluids during labor and
birth, ingestion of breast milkbirth, ingestion of breast milk
 SYPHILLIS (TREPONEMA PALLIDUM) –SYPHILLIS (TREPONEMA PALLIDUM) –
sexually transmitted disease caused by thesexually transmitted disease caused by the
spirochete, treponema pallidum.spirochete, treponema pallidum.
Transplacental transmission is possible afterTransplacental transmission is possible after
the 16the 16thth
to 18to 18thth
week of pregnancy resulting inweek of pregnancy resulting in
stillbirth or congenital syphillis.stillbirth or congenital syphillis.

57.  RUBELLA (GERMAN or 3 DAYRUBELLA (GERMAN or 3 DAY
Measles)- Viral infection transmitted byMeasles)- Viral infection transmitted by
dropletsdroplets
 CYTOMEGALOVIRUS – Viral infectionCYTOMEGALOVIRUS – Viral infection
transmitted by contact with contaminatedtransmitted by contact with contaminated
saliva respiratory secretions, urine,saliva respiratory secretions, urine,
semen, breastmilk, blood cervical-vaginalsemen, breastmilk, blood cervical-vaginal
secretions. Most often asymptomatic insecretions. Most often asymptomatic in
the mother but produces several fetalthe mother but produces several fetal
and neonatal effects including hemolyticand neonatal effects including hemolytic
anemia, jaundice, hydrocephaly-anemia, jaundice, hydrocephaly-
microcephaly, pneumonitis, mentalmicrocephaly, pneumonitis, mental
retardationretardation

58.  H - HERPES – SIMPLEX VIRUS – aH - HERPES – SIMPLEX VIRUS – a
sexually transmitted viral infection thatsexually transmitted viral infection that
occurs when contact is made withoccurs when contact is made with
contaminated genital secretions. Infectedcontaminated genital secretions. Infected
women can infect fetus transplacentallywomen can infect fetus transplacentally
especially during a primary infectionespecially during a primary infection
when systemic findings occur and arewhen systemic findings occur and are
most severe and through contact withmost severe and through contact with
other lesions and contaminatedother lesions and contaminated
secretions during passage through thesecretions during passage through the
birth canal.birth canal.

59. CARDIOVASCULCARDIOVASCUL
AR SYSTEMAR SYSTEM
 First systems to becomeFirst systems to become
functional in intrauterine lifefunctional in intrauterine life
 Forms as early as 16Forms as early as 16thth
day of life,day of life,
beating as early as the 24beating as early as the 24thth
dayday
 The heartbeat maybe heard withThe heartbeat maybe heard with
a Doppler as early as the 10a Doppler as early as the 10thth
toto
11th week of pregnancy11th week of pregnancy
 After the 28After the 28thth
week of pregnancy,week of pregnancy,
the heart rate begins to show athe heart rate begins to show a
baseline variability of about 5baseline variability of about 5
beats per minutebeats per minute

60. FETAL CIRCULATIONFETAL CIRCULATION
 PLACENTA ---- OXYGENATED BLOODPLACENTA ---- OXYGENATED BLOOD
IS CARRIED BY THE VEIN ---- LIVERIS CARRIED BY THE VEIN ---- LIVER
---- DUCTUS VENOSUS ---- INFERIOR---- DUCTUS VENOSUS ---- INFERIOR
VENACAVA ---- RIGHT ATRIUM ---- 70VENACAVA ---- RIGHT ATRIUM ---- 70
% SHUNTED TO FORAMEN OVALE ----% SHUNTED TO FORAMEN OVALE ----
LEFT ATRIUM ---- MITRAL VALVE ----LEFT ATRIUM ---- MITRAL VALVE ----
LEFT VENTRICLE ---- AORTA ----LEFT VENTRICLE ---- AORTA ----
LOWER EXTREMITIESLOWER EXTREMITIES

62.  The remaining 30 % ---- tricuspid valveThe remaining 30 % ---- tricuspid valve
---- right ventricle ---- pulmonary artery---- right ventricle ---- pulmonary artery
---- lungs ---- vasoconstriction of lungs---- lungs ---- vasoconstriction of lungs
pushes the blood to Ductus arteriosuspushes the blood to Ductus arteriosus
---- aorta ---- to supply the upper---- aorta ---- to supply the upper
extremities.extremities.

63. FetalFetal
HemoglobinHemoglobin
 Fetal hemoglobin has greaterFetal hemoglobin has greater
oxygen affinity, which increasesoxygen affinity, which increases
its efficiency, and is moreits efficiency, and is more
concentratedconcentrated
 Hemoglobin level at birth isHemoglobin level at birth is
about 17.1 g/100ml (Adultabout 17.1 g/100ml (Adult
11g/100ml)11g/100ml)
 Hematocrit is about 53 % (adultHematocrit is about 53 % (adult
45 %)45 %)

64. RESPIRATORYRESPIRATORY
SYSTEMSYSTEM
 77thth
week of life DIAPHRAGMweek of life DIAPHRAGM
completely divide the thoracic cavitycompletely divide the thoracic cavity
from abdominal cavityfrom abdominal cavity
 Alveoli and Capillaries begin to formAlveoli and Capillaries begin to form
between 24between 24thth
and 28and 28thth
weeks.weeks.
 Continues respiratory movementsContinues respiratory movements
begins as early as 3 months ofbegins as early as 3 months of
pregnancypregnancy
 Surfactant is formed and excretedSurfactant is formed and excreted
by the alveolar cells at about the 24by the alveolar cells at about the 24thth
weekweek

65.  Analysis of the Lecithin/sphingomyelinAnalysis of the Lecithin/sphingomyelin
(LS) ratio by an amniocentesis technique(LS) ratio by an amniocentesis technique
is one of the primary tests for fetalis one of the primary tests for fetal
maturitymaturity
 L/S ratio is 2:1, at about 35 weeks, thereL/S ratio is 2:1, at about 35 weeks, there
is a surge in the production of lecithin.is a surge in the production of lecithin.

66. NERVOUS SYSTEMNERVOUS SYSTEM
 Active formation of the nervous system andActive formation of the nervous system and
sense organs has already begun during the 3sense organs has already begun during the 3rdrd
and 4and 4thth
week of life.week of life.
 Brain waves can be detected on anBrain waves can be detected on an
electroencephalogram (EEG) by the 8electroencephalogram (EEG) by the 8thth
weekweek
 By 24 weeks, the ear is capable of respondingBy 24 weeks, the ear is capable of responding
to sound; the eyes exhibit a pupillary reaction,to sound; the eyes exhibit a pupillary reaction,
indicating sight is presentindicating sight is present
 Brain growth continue to occur rapidly during 1Brain growth continue to occur rapidly during 1stst
year and continues at high levels until 5 or 6year and continues at high levels until 5 or 6
years of age.years of age.

67. DIGESTIVEDIGESTIVE
SYSTEMSYSTEM
 MECONIUM forms in theMECONIUM forms in the
intestines as early as the 16intestines as early as the 16thth
weekweek
 Meconium is black or dark greenMeconium is black or dark green
( obtaining its color( obtaining its color
from bile pigment) and stickyfrom bile pigment) and sticky
 It consist of cellular wastes, bile,It consist of cellular wastes, bile,
fats, mucoprotein,fats, mucoprotein,
mucopolysaccharides, andmucopolysaccharides, and
vernix caseosa, lubricatingvernix caseosa, lubricating
sustance that forms the fetal skinsustance that forms the fetal skin

68.  Gastrointestinal tract is sterile beforeGastrointestinal tract is sterile before
birth.birth.
 Vit K, essential for blood clotting, isVit K, essential for blood clotting, is
synthesized by the action of bacteriasynthesized by the action of bacteria
in the intestines, this can causein the intestines, this can cause
vitamin K levels to be low in thevitamin K levels to be low in the
newborn.newborn.
 Sucking and swallowing reflexesSucking and swallowing reflexes
matures at 32 weeks or until fetusmatures at 32 weeks or until fetus
weighs 1500 g.weighs 1500 g.
 GIT secretes enzymes essential forGIT secretes enzymes essential for
digestion of CHO and CHON at 36digestion of CHO and CHON at 36
weeksweeks

69.  Many newborn have not yet developMany newborn have not yet develop
lipase, an enzyme needed for fatlipase, an enzyme needed for fat
digestion.digestion.
 Amylase is not mature until 3 monthsAmylase is not mature until 3 months
after birthafter birth
 Liver is active throughout gestation,Liver is active throughout gestation,
function as filter between incoming bloodfunction as filter between incoming blood
and fetal circulation and as a deposit forand fetal circulation and as a deposit for
fetal stores such as iron and glycogen.fetal stores such as iron and glycogen.
 Hypoglycemia and hyperbilirubinemiaHypoglycemia and hyperbilirubinemia
two serious problems in the first 24 hourstwo serious problems in the first 24 hours
after birth.after birth.

70. MUSCULOSKELETMUSCULOSKELET
AL SYSTEMAL SYSTEM
 Fetus can be seen to move onFetus can be seen to move on
ultrasound as early as the 11ultrasound as early as the 11thth
week, although the mother usuallyweek, although the mother usually
does not feel this movementdoes not feel this movement
(QUICKENING) until nearly 20(QUICKENING) until nearly 20
weeks.weeks.
 Ossification of bone tissue beginsOssification of bone tissue begins
about 12about 12thth
week.week.

71. REPRODUCTIVEREPRODUCTIVE
SYSTEMSYSTEM Child sex is determined at the moment ofChild sex is determined at the moment of
conception by a spermatozoon carryingconception by a spermatozoon carrying
an X or a Y chromosomes.an X or a Y chromosomes.
 Can be determined as early as 8 weeksCan be determined as early as 8 weeks
by chromosomal analysisby chromosomal analysis
 The GONADS form at about 6The GONADS form at about 6thth
weeks ofweeks of
lifelife
 Testes descend from pelvic cavity at 34Testes descend from pelvic cavity at 34thth
– 38– 38thth
weekweek

72. URINARY SYSTEMURINARY SYSTEM
 Rudimentary kidneys are present as early asRudimentary kidneys are present as early as
the end of the 4the end of the 4thth
weekweek
 Urine is formed by the 4Urine is formed by the 4thth
week and excreted inweek and excreted in
the amniotic fluid by 16the amniotic fluid by 16thth
weekweek
 At term fetal urine is being excreted at the rateAt term fetal urine is being excreted at the rate
of 500ml/dayof 500ml/day
 OLIGOHYDRAMNIOS an amount of amnioticOLIGOHYDRAMNIOS an amount of amniotic
fluid that is < normal suggest that fetal kidneysfluid that is < normal suggest that fetal kidneys
are not secreting adequate urineare not secreting adequate urine

73. INTEGUMENTARYINTEGUMENTARY
SYSTEMSYSTEM
 The skin of the fetus appears thin andThe skin of the fetus appears thin and
almost translucentalmost translucent
 Subcutaneous fat begins to be depositedSubcutaneous fat begins to be deposited
at about 36 weeksat about 36 weeks
 Skin is covered by soft downy hairsSkin is covered by soft downy hairs
(LANUGO) and a cream cheese-like(LANUGO) and a cream cheese-like
substance, vernix caseosa, which issubstance, vernix caseosa, which is
important for lubrication and keeping theimportant for lubrication and keeping the
skin from maceratingskin from macerating

74. IMMUNE SYSTEMIMMUNE SYSTEM
 IgG maternal antibodies cross theIgG maternal antibodies cross the
placenta into the fetus during the 3placenta into the fetus during the 3rdrd
trimester of pregnancy (Giving fetustrimester of pregnancy (Giving fetus
temporary passive immunity)temporary passive immunity)
 Little or no immunity to Herpes virusLittle or no immunity to Herpes virus
 Level of passive IgG immunoglobulinsLevel of passive IgG immunoglobulins
peaks at birth, then decreases by thepeaks at birth, then decreases by the
next 8 monthsnext 8 months

75. MILESTONES OF FETALMILESTONES OF FETAL
GROWTH ANDGROWTH AND
DEVELOPMENTDEVELOPMENT

77. End of 4 GestationEnd of 4 Gestation
WeeksWeeks
 Length: .75 to 1 cmLength: .75 to 1 cm
 Weight: 400 mgWeight: 400 mg
 Spinal cord is formed and fused at theSpinal cord is formed and fused at the
midpointmidpoint
 Lateral wing that form the body are foldedLateral wing that form the body are folded
forward to fuse at the midlineforward to fuse at the midline
 Head folds forward, becoming prominent,Head folds forward, becoming prominent,
representing about 1/3 of the entirerepresenting about 1/3 of the entire
structurestructure
 The back is bent so the head almostThe back is bent so the head almost
touches the tip of the tailtouches the tip of the tail
 Arms and legs are budlike structuresArms and legs are budlike structures
 Rudimentary eyes, ears and nose areRudimentary eyes, ears and nose are
discerniblediscernible

79. End of 8End of 8thth
GestationGestation
weeksweeks
 Length: 2.5 cm (1in)Length: 2.5 cm (1in)
 Weight: 20 gWeight: 20 g
 Organogenesis is completeOrganogenesis is complete
 The heart with septum and valves, isThe heart with septum and valves, is
beating rhythmicallybeating rhythmically
 Facial features are definitely discernibleFacial features are definitely discernible
 Extremities have developedExtremities have developed
 External genitalia are present, but sex is notExternal genitalia are present, but sex is not
distinguishabledistinguishable
 Primitive tail is regressingPrimitive tail is regressing
 Abdomen appears large as the fetal intestine isAbdomen appears large as the fetal intestine is
growing rapidlygrowing rapidly

80. End of 12End of 12thth
Gestation weekGestation week Length: 7 to 8 cmLength: 7 to 8 cm
 Weight: 45 gWeight: 45 g
 Nail beds are forming on fingersNail beds are forming on fingers
and toesand toes
 Spontaneous movement areSpontaneous movement are
possiblepossible
 Babinski reflex are presentBabinski reflex are present
 Bone ossification centers areBone ossification centers are
presentpresent
 Sex is distinguishable by outwardSex is distinguishable by outward
appearanceappearance
 Kidney secretion has begunKidney secretion has begun
 Heartbeat is audible by a dopplerHeartbeat is audible by a doppler

81. End of 16End of 16thth
GestationGestation
weekweek Length: 10 – 17 cmLength: 10 – 17 cm
 Weight:4Weight:4
 55 – 120 g55 – 120 g
 Fetal heart sounds are audible with anFetal heart sounds are audible with an
ordinary stethoscopeordinary stethoscope
 Lanugo (fine downy hair on the back andLanugo (fine downy hair on the back and
arms of newborns, servin as a source ofarms of newborns, servin as a source of
insulation for body heat) is well formedinsulation for body heat) is well formed
 Liver and pancreas are functioningLiver and pancreas are functioning
 Sex can be determined by ultrasoundSex can be determined by ultrasound
 Fetus actively swallows amniotic fluidFetus actively swallows amniotic fluid
 Urine is present in amniotic fluidUrine is present in amniotic fluid

82. End of 20 gestationEnd of 20 gestation
WeeksWeeks
 Length: 25 cmLength: 25 cm
 Weight: 223cmWeight: 223cm
 Spontaneous fetal movements can beSpontaneous fetal movements can be
sensed by the mothersensed by the mother
 Antibody production is possibleAntibody production is possible
 Hair forms (eyebrows and hair on theHair forms (eyebrows and hair on the
head)head)
 Meconium is present in the upperMeconium is present in the upper
intestineintestine

83.  Brown fat begins to be formed behind theBrown fat begins to be formed behind the
kidneys, sternum and posterior neck.kidneys, sternum and posterior neck.
 Fetal heartbeat is strong enough to beFetal heartbeat is strong enough to be
audible through the abdomen with anaudible through the abdomen with an
ordinary stethoscopeordinary stethoscope
 Vernix caseosa, a cream cheese-likeVernix caseosa, a cream cheese-like
substance produced by thesubstance produced by the
sebaceous glands that serves as asebaceous glands that serves as a
protective skin covering duringprotective skin covering during
intrauterine life begins to formintrauterine life begins to form
 Definite sleping and activity patterns areDefinite sleping and activity patterns are
distinguishabledistinguishable

84. End of 24 GestationEnd of 24 Gestation
WeeksWeeks
 Length: 28 to 36 cmLength: 28 to 36 cm
 Weight: 550 gWeight: 550 g
 Meconium is present as far as the rectumMeconium is present as far as the rectum
 Active production of lung surfactantActive production of lung surfactant
beginsbegins
 Eyebrows and eyelashes are wellEyebrows and eyelashes are well
defineddefined
 Eyelids are now openEyelids are now open
 Pupils are capable of reacting to lightPupils are capable of reacting to light
 Hearing can be demonstrated byHearing can be demonstrated by

86. End of 28End of 28thth
GestationGestation
weeksweeks Length: 35 to 38 cmLength: 35 to 38 cm
 Weight: 1,200gWeight: 1,200g
 Lung alveoli begin to mature;Lung alveoli begin to mature;
surfactant can be demonstrated insurfactant can be demonstrated in
amniotic fluidamniotic fluid
 Testes begin to descend into the scrotalTestes begin to descend into the scrotal
sac from the lower abdominal cavitysac from the lower abdominal cavity
 The blood vessels of the retina areThe blood vessels of the retina are
extremely susceptible to damage fromextremely susceptible to damage from
high O2 concentrationshigh O2 concentrations
 The eyes openThe eyes open

87. End of 32 GestationEnd of 32 Gestation
WeeksWeeks Length: 38Length: 38thth
to 43 cmto 43 cm
 Weight: 1600gWeight: 1600g
 Subcutaneous fat begins to be depositedSubcutaneous fat begins to be deposited
 Fetus is aware of sounds outside theFetus is aware of sounds outside the
mother’s bodymother’s body
 Active Moro reflex is presentActive Moro reflex is present
 Birth position may be assumedBirth position may be assumed
 Iron stores are beginning to beIron stores are beginning to be
developeddeveloped
 Fingernails grow to reach the end ofFingernails grow to reach the end of
fingertipsfingertips

88. End of 36 GestationEnd of 36 Gestation
WeeksWeeks
 Length: 42 – 48 cmLength: 42 – 48 cm
 Weight: 1800 – 2700 gWeight: 1800 – 2700 g
 Body source of calcium glycogen, ironBody source of calcium glycogen, iron
and carbohydrates are augmentedand carbohydrates are augmented
 Additional amount of subcutaneous fatAdditional amount of subcutaneous fat
are depositedare deposited
 Amount of lanugo begins to diminishAmount of lanugo begins to diminish
 Sole of the foot has only one or twoSole of the foot has only one or two
crisscross creasescrisscross creases

89. End of 40 GestationEnd of 40 Gestation
WeeksWeeks
 Length: 48 – 52 cmLength: 48 – 52 cm
 Weight: 3000 gWeight: 3000 g
 Fetus kicks actively strong enough toFetus kicks actively strong enough to
cause considerable discomfortcause considerable discomfort
 Vernix caseosa is fully formedVernix caseosa is fully formed
 Fingernails extend over the fingertipsFingernails extend over the fingertips
 Creases on the sole of the feet coverCreases on the sole of the feet cover
atleast 2/3 of the surfaceatleast 2/3 of the surface
 Fetal Hgb begin its conversion to adultFetal Hgb begin its conversion to adult
HgbHgb

90. Determination of EstimatedDetermination of Estimated
Birth DateBirth Date
 NAGELE’S RULENAGELE’S RULE
 To calculate the date of birth by this ruleTo calculate the date of birth by this rule
count backward 3 calendar months from thecount backward 3 calendar months from the
first day of the last menstrual period and addfirst day of the last menstrual period and add
7 days.7 days.

91. Estimating Fetal GrowthEstimating Fetal Growth
 McDONALD’S RULEMcDONALD’S RULE
 Is a method of determining, during midIs a method of determining, during mid
pregnancy that the fetus is growing inpregnancy that the fetus is growing in
utero by measuring fundal (uterine)utero by measuring fundal (uterine)
height.height.
 The measurement is made from theThe measurement is made from the
notch of symphysis pubis to over the topnotch of symphysis pubis to over the top
of the uterine fundus as the woman liesof the uterine fundus as the woman lies
supinesupine

92. PHYSIOLOGICALPHYSIOLOGICAL
ADAPTATION OF THEADAPTATION OF THE
MOTHER TO PREGNANCYMOTHER TO PREGNANCY

93. SYSTEMIC CHANGESSYSTEMIC CHANGES
 CARDIOVASCULAR SYSTEMCARDIOVASCULAR SYSTEM
 Normal increase in blood volume by 30 – 50 % - forNormal increase in blood volume by 30 – 50 % - for
an adequate exchange of nutrients in the placentaan adequate exchange of nutrients in the placenta
and to provide adequate blood to compensate forand to provide adequate blood to compensate for
blood loss at birthblood loss at birth
 Increase in plasma volumeIncrease in plasma volume
 Increase in cardiac workload: causes lassitude orIncrease in cardiac workload: causes lassitude or
easy fatigueability and hypertrophy of the hearteasy fatigueability and hypertrophy of the heart
 PalpitationsPalpitations
 Epistaxis d/t hyperemia of mucous membraneEpistaxis d/t hyperemia of mucous membrane
 Supine Hypotension SyndromeSupine Hypotension Syndrome
 BP does not normally riseBP does not normally rise

94.  Because of poor circulation resultingBecause of poor circulation resulting
from pressure of the gravid uterus on thefrom pressure of the gravid uterus on the
blood vessels of the lower extremities;blood vessels of the lower extremities;
 Edema of the LE occurs: Mgt: raise the legsEdema of the LE occurs: Mgt: raise the legs
above hip levelabove hip level
 Varicosities of the lower extremities can alsoVaricosities of the lower extremities can also
occur. Management:occur. Management:
 Wear support hose or elastic stockings toWear support hose or elastic stockings to
promote venous flowpromote venous flow
 Apply elastic bandageApply elastic bandage
 Avoid use of constricting garter (knee highAvoid use of constricting garter (knee high
stockings)stockings)

95.  Physiologic Anemia (Pseudo anemia ofPhysiologic Anemia (Pseudo anemia of
pregnancy) Normal value: Hct (32-42%),pregnancy) Normal value: Hct (32-42%),
Hgb (10.5-14 g/dl)Hgb (10.5-14 g/dl)
 Criteria: 1Criteria: 1stst
and 3and 3rdrd
Trimester – HgbTrimester – Hgb
>11g/dl, Hct > 33%, 2>11g/dl, Hct > 33%, 2ndnd
Trimester – HgbTrimester – Hgb
<10.5 g/dl / Hct < 32%<10.5 g/dl / Hct < 32%
 Pathologic Anemia – Iron DeficiencyPathologic Anemia – Iron Deficiency
Anemia – is the most commonAnemia – is the most common
hematologic disorder. It affects roughlyhematologic disorder. It affects roughly
20 % of pregnant women20 % of pregnant women
 Assessment: pallor, slowed capillary refill,Assessment: pallor, slowed capillary refill,
concave finger nail, constipationconcave finger nail, constipation

96.  Nursing care:Nursing care:
 Nutritional instructions: swamp cabbage,Nutritional instructions: swamp cabbage,
kangkong, liver and red meatkangkong, liver and red meat
 Parenteral Iron (Imferon): Z-tract techniqueParenteral Iron (Imferon): Z-tract technique
 Oral iron supplements (ferrous sulfate 0.3 g,Oral iron supplements (ferrous sulfate 0.3 g,
3 times a day)3 times a day)
 Monitor for hemorrhageMonitor for hemorrhage
 Nursing alerts: iron is better absorbed whenNursing alerts: iron is better absorbed when
taken with foods high in Vitamin C such astaken with foods high in Vitamin C such as
orange juiceorange juice
 Higher iron intake is recommended sinceHigher iron intake is recommended since
circulating blood volume is increased andcirculating blood volume is increased and
Heme is required from production of RBCsHeme is required from production of RBCs

97. GASTROINTESTINALGASTROINTESTINAL
SYSTEMSYSTEM
 At midpoint of pregnancy, the pressureAt midpoint of pregnancy, the pressure
may be sufficient to slow intestinalmay be sufficient to slow intestinal
peristalsis and the emptying time of theperistalsis and the emptying time of the
stomach, leading to heartburn,stomach, leading to heartburn,
constipation and flatulenceconstipation and flatulence
 Morning sickness, nausea and vomitingMorning sickness, nausea and vomiting
bein to be noticed at the time that levelsbein to be noticed at the time that levels
of Hcg and progesterone begin to riseof Hcg and progesterone begin to rise

98.  Management for morning sickness – EatManagement for morning sickness – Eat
dry toast or crackers 30 minutes beforedry toast or crackers 30 minutes before
arising in the morning or dry high CHO,arising in the morning or dry high CHO,
low fat or low spices in the diet.low fat or low spices in the diet.
 Hyperemesis Gravidarum – excessiveHyperemesis Gravidarum – excessive
nausea and vomiting which persistnausea and vomiting which persist
beyond 3 months; results in dehydration,beyond 3 months; results in dehydration,
starvation and acidosis.starvation and acidosis.
 Management: D10 NSS 3000ml is theManagement: D10 NSS 3000ml is the
priority treatment; complete bed rest ispriority treatment; complete bed rest is
also importantalso important

99.  Decrease emptying of bile fromDecrease emptying of bile from
Gallbladder due to gradual slowing ofGallbladder due to gradual slowing of
gastrointestinal tractgastrointestinal tract
 Reabsorption of bilirubin to maternalReabsorption of bilirubin to maternal
bloodstream, giving rise to symptom ofbloodstream, giving rise to symptom of
generalized itching (subclinical jaundice)generalized itching (subclinical jaundice)
 Hypertrophy of gumlines and bleeding ofHypertrophy of gumlines and bleeding of
gingival tissue when they brush theirgingival tissue when they brush their
teethteeth
 Hyperptyalism – increased salivaHyperptyalism – increased saliva
formation as local response to increaseformation as local response to increase
levels of estrogenlevels of estrogen

100.  Flatulence and constipation is common due toFlatulence and constipation is common due to
increase progesterone and displacement ofincrease progesterone and displacement of
stomach and intestines, thus slowing gastricstomach and intestines, thus slowing gastric
emptying time.emptying time.
 Hemorrhoids due to gravid uterusHemorrhoids due to gravid uterus
 Heartburn due to pyrosis or reflux of stomachHeartburn due to pyrosis or reflux of stomach
content to the esophaguscontent to the esophagus
 Improve condition of peptic ulcer duringImprove condition of peptic ulcer during
pregnancy because the acidity of the stomachpregnancy because the acidity of the stomach
is decreaseis decrease
 Relaxin may contribute to decreased gastricRelaxin may contribute to decreased gastric
motilitymotility

101. RESPIRATORY SYSTEMRESPIRATORY SYSTEM
 Shortness of breathShortness of breath
 Diaphragm may be displaced by as much as 4Diaphragm may be displaced by as much as 4
cm upwardcm upward
 Total oxygen consumption increases by asTotal oxygen consumption increases by as
much as 20%much as 20%
 The fetal CO2 level is higher than that in theThe fetal CO2 level is higher than that in the
mother, allowing CO2 to cross readily from themother, allowing CO2 to cross readily from the
fetus to the motherfetus to the mother
 Mild hyperventilationMild hyperventilation
 Congestion and stuffiness of the nasopharynx,Congestion and stuffiness of the nasopharynx,
a response to increase estrogen levela response to increase estrogen level

102. URINARY SYSTEMURINARY SYSTEM
 Urinary frequency, the only sign inUrinary frequency, the only sign in
pregnancy seen during the 1pregnancy seen during the 1stst
trimester,trimester,
disappear during the 2disappear during the 2ndnd
trimester andtrimester and
reappears during the 3reappears during the 3rdrd
trimestertrimester
 Early in pregnancy is due to increasedEarly in pregnancy is due to increased
blood supply to the kidneys and to theblood supply to the kidneys and to the
uterus rising out of the pelvic cavity.uterus rising out of the pelvic cavity.
 In the last trimester is due to pressure ofIn the last trimester is due to pressure of
enlarged uterus on the bladder,enlarged uterus on the bladder,
especially with lighteningespecially with lightening

103.  Decreased renal threshold for sugar dueDecreased renal threshold for sugar due
to increased production ofto increased production of
glucocorticoids which cause lactose andglucocorticoids which cause lactose and
dextrose to spill into the urine; also andextrose to spill into the urine; also an
effect of the increased progesteroneeffect of the increased progesterone

104. MUSCULOSKELETALMUSCULOSKELETAL
CHANGESCHANGES
 Because of the pregnant woman’s attempt toBecause of the pregnant woman’s attempt to
change her center of gravity; she makeschange her center of gravity; she makes
ambulation easier by standing more straightambulation easier by standing more straight
and taller, resulting in aand taller, resulting in a lordotic positionlordotic position
“pride of pregnancy”“pride of pregnancy”
 Increased production of the hormoneIncreased production of the hormone
RELAXIN, pelvic bones become more suppleRELAXIN, pelvic bones become more supple
and movable, increasing the incidence ofand movable, increasing the incidence of
accidental falls due to the wobbly gait.accidental falls due to the wobbly gait.
 Advise use of low heeled shoes after the firstAdvise use of low heeled shoes after the first
trimestertrimester

105.  Leg crampsLeg cramps
 Causes:Causes:
 Increased pressure of gravid uterus on lowerIncreased pressure of gravid uterus on lower
extremitiesextremities
 FatigueFatigue
 ChillsChills
 Muscle tensenessMuscle tenseness
 Low calcium, high phosphorus intakeLow calcium, high phosphorus intake
 Management: press knee of the affected legManagement: press knee of the affected leg
and dorsiflex the footand dorsiflex the foot
 Do not massage and wear warm, moreDo not massage and wear warm, more
comfortable clothingcomfortable clothing

106. TEMPERATURETEMPERATURE
 Slight increase in basal bodySlight increase in basal body
temperature due to increasedtemperature due to increased
progesterone, but the body adapts afterprogesterone, but the body adapts after
the 4the 4thth
monthmonth
 As the placenta takes over the function ofAs the placenta takes over the function of
the corpus luteum at about 16 weeks, thethe corpus luteum at about 16 weeks, the
temperature generally decreases totemperature generally decreases to
normalnormal

107. INTEGUMENTARYINTEGUMENTARY
SYSTEMSYSTEM
 Striae gravidarum – pink or reddishStriae gravidarum – pink or reddish
streaks appearing on the sides of thestreaks appearing on the sides of the
abdominal wall and sometimes on theabdominal wall and sometimes on the
thigh.thigh.
 In the weeks after birth, striaeIn the weeks after birth, striae
gravidarum lighten to a silvery – whitegravidarum lighten to a silvery – white
color (striae albicantes or atrophicae)color (striae albicantes or atrophicae)
and although permanent, become barelyand although permanent, become barely
noticeablenoticeable

108.  Diastasis - separation of the rectusDiastasis - separation of the rectus
musclesmuscles
 The umbilicus is stretched by pregnancyThe umbilicus is stretched by pregnancy
to such an extent that by the 28to such an extent that by the 28thth
week,week,
its depression becomes obliterated andits depression becomes obliterated and
smooth because it has been pushed sosmooth because it has been pushed so
far outwardfar outward
 Extra pigmentation, a brown line (lineaExtra pigmentation, a brown line (linea
nigra) may be present, running from thenigra) may be present, running from the
umbilicus to the symphysis pubis andumbilicus to the symphysis pubis and
separating the abdomen into a right andseparating the abdomen into a right and
left hemisphereleft hemisphere

109.  MELASMA (CHLOASMA) or the mask ofMELASMA (CHLOASMA) or the mask of
pregnancy – darkened areas on the face,pregnancy – darkened areas on the face,
cheeks and across the nosecheeks and across the nose
 Palmar erythema (redness and itching)Palmar erythema (redness and itching)
 Increase sweat gland activityIncrease sweat gland activity
 Vascular spiders (small fiery red-Vascular spiders (small fiery red-
branching spots)branching spots)

110. ENDOCRINE CHANGESENDOCRINE CHANGES
 Addition of the placenta as an endocrineAddition of the placenta as an endocrine
organ, producing large amounts of HCG,organ, producing large amounts of HCG,
estrogen and progesteroneestrogen and progesterone
 Moderate enlargement of the thyroidModerate enlargement of the thyroid
gland due to hyperplasia of glandulargland due to hyperplasia of glandular
tissues and increased vascularity.tissues and increased vascularity.
 Increased size of the parathyroidIncreased size of the parathyroid
probably to satisfy the increase need ofprobably to satisfy the increase need of
the fetus for calciumthe fetus for calcium

111.  Increased size and activity of the adrenalIncreased size and activity of the adrenal
cortex, thus increasing the amount ofcortex, thus increasing the amount of
circulating cortisol, aldosterone and ADHcirculating cortisol, aldosterone and ADH
all of which affect CHO and fatall of which affect CHO and fat
metabolism, causing hyperglycemiametabolism, causing hyperglycemia
 Gradual increase in insulin productionGradual increase in insulin production
but the body’s sensitivity to insulin isbut the body’s sensitivity to insulin is
decreased during pregnancydecreased during pregnancy

112. LOCAL CHANGESLOCAL CHANGES
 UTERUSUTERUS
 Weight increases to about 1000g at full termWeight increases to about 1000g at full term
 Change in shape from pear-like to ovoidChange in shape from pear-like to ovoid
 HEGAR sign – change in consistency ofHEGAR sign – change in consistency of
lower uterine segment, seen at about 6lower uterine segment, seen at about 6thth
weeksweeks
 Operculum – mucus plug in the cervix, whichOperculum – mucus plug in the cervix, which
is produce to seal out bacteriais produce to seal out bacteria
 Goodles sign – cervix becomes moreGoodles sign – cervix becomes more
vascular and edematous resembling thevascular and edematous resembling the
consistency of an earlobeconsistency of an earlobe

113.  BALLOTMENT – 16BALLOTMENT – 16thth
to 20to 20thth
week ofweek of
pregnancy (‘from the french wordpregnancy (‘from the french word
balloter, meaning to toss about’)balloter, meaning to toss about’)
 BRAXTON HICKS CONTRACTIONs -BRAXTON HICKS CONTRACTIONs -
uterine contraction beginning early inuterine contraction beginning early in
pregnancy, at least by 12 th week andpregnancy, at least by 12 th week and
are present throughout the rest ofare present throughout the rest of
pregnancy.pregnancy.
 A waves of tightness or hardness acrossA waves of tightness or hardness across
her abdomenher abdomen

114. AmenorrheaAmenorrhea
 Absence of menstruation because of theAbsence of menstruation because of the
suppression of follicle stimulatingsuppression of follicle stimulating
hormonehormone
 A presumptive sign of pregnancyA presumptive sign of pregnancy

115. CERVICAL CHANGESCERVICAL CHANGES
 Cervix becomes more vascular andCervix becomes more vascular and
edematous due to increasing level ofedematous due to increasing level of
circulating estrogencirculating estrogen
 Presence of tenacious coating of mucousPresence of tenacious coating of mucous
plug which act to seal out bacteria duringplug which act to seal out bacteria during
pregnancy and so help prevent infectionpregnancy and so help prevent infection
in the fetus and membranesin the fetus and membranes
(OPERCULUM)(OPERCULUM)

116.  GOODELL’S SIGN – softening of theGOODELL’S SIGN – softening of the
pelvispelvis
 the consistency of a nonpregnant cervixthe consistency of a nonpregnant cervix
may be compared with that of the nose,may be compared with that of the nose,
whereas the consistency of a pregnantwhereas the consistency of a pregnant
cervix more closely resembles that of ancervix more closely resembles that of an
earlobeearlobe
 Just before labor, the cervix becomes soJust before labor, the cervix becomes so
soft that it takes on the consistency ofsoft that it takes on the consistency of
butter and is said to be ripe for birthbutter and is said to be ripe for birth

117. VAGINAL CHANGESVAGINAL CHANGES
 Vaginal epithelium and underlying tissueVaginal epithelium and underlying tissue
become hypertrophic and enriched withbecome hypertrophic and enriched with
glycogenglycogen
 CHADWICK’S SIGN – the resulting increase inCHADWICK’S SIGN – the resulting increase in
circulation to the vagina changes the color ofcirculation to the vagina changes the color of
the vaginal walls from the normal light pink to athe vaginal walls from the normal light pink to a
deep violetdeep violet
 Vaginal secretions during pregnancy fall from aVaginal secretions during pregnancy fall from a
pH of over 7 (an alkaline pH0 to 4 or 5 (an acidpH of over 7 (an alkaline pH0 to 4 or 5 (an acid
pH) due to Lactobacillus acidophilus bacteria.pH) due to Lactobacillus acidophilus bacteria.

118.  This changing acid content makes theThis changing acid content makes the
vagina resistant to bacterial invasion forvagina resistant to bacterial invasion for
the length of pregnancythe length of pregnancy
 Unfortunately, favors the growth ofUnfortunately, favors the growth of
Candida Albicans, a species of yeastlikeCandida Albicans, a species of yeastlike
fungi.fungi.
 Manifested by an ithching, burningManifested by an ithching, burning
sensation in addition to a cream cheesesensation in addition to a cream cheese
like discharge.like discharge.

119. OVARIAN CHANGESOVARIAN CHANGES
 Ovulation stops with pregnancy.Ovulation stops with pregnancy.
Progesterone and estrogen are beingProgesterone and estrogen are being
produced by the placentaproduced by the placenta

120. ABDOMINAL WALLABDOMINAL WALL
CHANGESCHANGES
 STRIAE GRAVIDARUM – increase inSTRIAE GRAVIDARUM – increase in
uterine size results in rupture anduterine size results in rupture and
atrophy of connective tissue layers, seenatrophy of connective tissue layers, seen
as pink or reddish streaksas pink or reddish streaks
 Umbilicus is pushed outUmbilicus is pushed out

121. SKINSKIN
 LINEA NIGRA – brown line running fromLINEA NIGRA – brown line running from
umbilicus to symphysis pubisumbilicus to symphysis pubis
 MELASMA OR CHLOASMA – extraMELASMA OR CHLOASMA – extra
pigmentation on cheeks and across thepigmentation on cheeks and across the
nose due to increased production ofnose due to increased production of
melanocytes by the pituitary glandmelanocytes by the pituitary gland
 Sweat glands unduly activatedSweat glands unduly activated

122. BREASTBREAST
 All changes due to increase in estrogenAll changes due to increase in estrogen
 Increase in size due to hyperplasia ofIncrease in size due to hyperplasia of
mammary alveoli and fat deposits.mammary alveoli and fat deposits.
Proper breast support with well fittingProper breast support with well fitting
brassiere necessary to prevent saggingbrassiere necessary to prevent sagging
 Feeling of fullness and tingling sensationFeeling of fullness and tingling sensation
in the breastin the breast
 Nipples more erectNipples more erect

123.  For mothers who intend to breast feed,For mothers who intend to breast feed,
advise:advise:
 Nipple rollingNipple rolling
 Drying nipples with rough towel to helpDrying nipples with rough towel to help
toughen the nipplestoughen the nipples
 Not to use soap or alcohol as this canNot to use soap or alcohol as this can
cause drying which could lead to sorecause drying which could lead to sore
nipplesnipples
 Montgomery glands become bigger andMontgomery glands become bigger and
more protuberant. This keeps the nipplesmore protuberant. This keeps the nipples
supple and prevent cracking and drying.supple and prevent cracking and drying.

124.  Areola becomes darker and diameterAreola becomes darker and diameter
increasesincreases
 Skin surrounding areola turns darkSkin surrounding areola turns dark
 By the fourth montha, a thin, watery, highBy the fourth montha, a thin, watery, high
protein fluid called colostrum, is formed.protein fluid called colostrum, is formed.
It is the precursor of breastmilkIt is the precursor of breastmilk

125. SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
OF PREGNANCYOF PREGNANCY
 PRESUMPTIVE – s/s felt and observePRESUMPTIVE – s/s felt and observe
by the mother but does not confirmby the mother but does not confirm
positive diagnosis of pregnancypositive diagnosis of pregnancy
 PROBABLE – Signs observe by thePROBABLE – Signs observe by the
members of health team but does notmembers of health team but does not
confirm a positive diagnosis of pregnancyconfirm a positive diagnosis of pregnancy
 POSITIVE SIGN – undeniable signsPOSITIVE SIGN – undeniable signs
confirmed by the use of instrumentsconfirmed by the use of instruments

126. FIRSTFIRST
TRIMESTERTRIMESTER
 PRESUMPTIVE:PRESUMPTIVE:
 B – reast changesB – reast changes
 U – rinary frequencyU – rinary frequency
 F – atigueF – atigue
 A – menorrheaA – menorrhea
 M – orning sicknessM – orning sickness
 E – nlarge uterusE – nlarge uterus

127. PROBABLEPROBABLE
 G – OODLES SIGNG – OODLES SIGN
 C –HADWICK SIGNC –HADWICK SIGN
 H – EGARSH – EGARS
 E – LEVATED BODY TEMPERATUREE – LEVATED BODY TEMPERATURE
 P – OSITIVE HCGP – OSITIVE HCG

128. POSITIVEPOSITIVE
 ULTRASOUNDULTRASOUND

129. SECOND TRIMESTERSECOND TRIMESTER
 PRESUMPTIVEPRESUMPTIVE
 C – LOASMAC – LOASMA
 L – INEA NIGRAL – INEA NIGRA
 I – NCREASED SKIN PIGMENTATIONI – NCREASED SKIN PIGMENTATION
 S – TRIAE GRAVIDARUMS – TRIAE GRAVIDARUM
 Q - UICKENINGQ - UICKENING

130. PROBABLEPROBABLE
 B – ALLOTMENTB – ALLOTMENT
 E – NLARGE ABDOMENE – NLARGE ABDOMEN
 B – RAXTON HICKS CONTRACTIONB – RAXTON HICKS CONTRACTION

131. POSITIVEPOSITIVE
 F – ETAL HEART TONEF – ETAL HEART TONE
 F – ETAL MOVEMENTF – ETAL MOVEMENT
 F – ETAL OUTLINEF – ETAL OUTLINE
 F – ETAL PARTS PALPABLEF – ETAL PARTS PALPABLE

132. PSYCHOLOGICALPSYCHOLOGICAL
ADAPTATION TOADAPTATION TO
PREGNANCYPREGNANCY
 FIRST TRIMESTERFIRST TRIMESTER
 NO TANGIBLE SIGN AND SYMPTOMSNO TANGIBLE SIGN AND SYMPTOMS
 FEELING OF SURPRISEFEELING OF SURPRISE
 MALADAPTATION: DENIAL OFMALADAPTATION: DENIAL OF
PREGNANCYPREGNANCY
 DEVELOPMENTAL TASK: TO ACCEPTDEVELOPMENTAL TASK: TO ACCEPT
BIOLOGICAL FACTS OF PREGNANCYBIOLOGICAL FACTS OF PREGNANCY
 FOCUS OF TEACHING: BODILYFOCUS OF TEACHING: BODILY
CHANGES OF PREGNANCYCHANGES OF PREGNANCY

133. SECOND TRIMESTERSECOND TRIMESTER
 TANGIBLE SIGN AND SYMPTOMS OFTANGIBLE SIGN AND SYMPTOMS OF
PREGNANCYPREGNANCY
 MOTHER IDENTIFIES fetus as aMOTHER IDENTIFIES fetus as a
separate identityseparate identity
 FantasyFantasy
 Developmental task: accept the growingDevelopmental task: accept the growing
fetus as a baby to be nurturedfetus as a baby to be nurtured
 Focus of health teaching: Growth andFocus of health teaching: Growth and
development of fetusdevelopment of fetus

134. THIRD TRIMESTERTHIRD TRIMESTER
 Mother has personal identification with theMother has personal identification with the
appearance of the babyappearance of the baby
 Mother has fearsMother has fears
 Let mother listen to FHT to ally fear of theLet mother listen to FHT to ally fear of the
 Developmental task: prepare for birth andDevelopmental task: prepare for birth and
parenting of the childparenting of the child
 Focus of health teaching: ResponsibleFocus of health teaching: Responsible
perenthood. Best time to prepare baby’sperenthood. Best time to prepare baby’s
layette, lamaze classeslayette, lamaze classes

135. Emotional Response toEmotional Response to
PregnancyPregnancy
 Ambivalence – interwoven feelings ofAmbivalence – interwoven feelings of
wanting and not wanting pregnancywanting and not wanting pregnancy
 Grief – contributed by giving up orGrief – contributed by giving up or
altering present roles to take on aaltering present roles to take on a
mothering rolemothering role
 Narcissism – self centeredness isNarcissism – self centeredness is
generally an early reaction to pregnancygenerally an early reaction to pregnancy

136.  Introversion vs. Extroversion –Introversion vs. Extroversion –
introversion or turning inward tointroversion or turning inward to
concentrate on oneself and one’s body,concentrate on oneself and one’s body,
is a common finding during pregnancyis a common finding during pregnancy
 StressStress
 Couvade syndrome – psychosomaticCouvade syndrome – psychosomatic
reaction wherein father experiences whatreaction wherein father experiences what
mother goes through. Men experiencesmother goes through. Men experiences
physical symptoms such as nauseaphysical symptoms such as nausea
vomiting and back ache.vomiting and back ache.

137.  Emotional Lability – mood changes dueEmotional Lability – mood changes due
to Hormonal changes, particularly theto Hormonal changes, particularly the
sustained increase in Estrogen andsustained increase in Estrogen and
ProgesteroneProgesterone
 Changes in sexual desire –Changes in sexual desire –
 First tri there is a decrease in libido becauseFirst tri there is a decrease in libido because
of the nausea, fatigue, and breastof the nausea, fatigue, and breast
tendernesstenderness
 During second trimester as blood flow to theDuring second trimester as blood flow to the
pelvic area increases to supply the placenta,pelvic area increases to supply the placenta,
libido and sexual enjoyment rise markedlylibido and sexual enjoyment rise markedly
 Third trimester it may remain high orThird trimester it may remain high or
decrease because of difficulty finding adecrease because of difficulty finding a
comfortable position and increasingcomfortable position and increasing
abdominal sign.abdominal sign.

138. The Pre-Natal VisitThe Pre-Natal Visit
 Basic considerationsBasic considerations
 Frequency of visit:Frequency of visit:
 1 to 7 month: once a month1 to 7 month: once a month
 8 to 9 months: Twice a month8 to 9 months: Twice a month
 10 months: every week10 months: every week
 The provision of prenat care is the primaryThe provision of prenat care is the primary
factor in the improvement of maternal andfactor in the improvement of maternal and
infant morbidity and mortality statistics.infant morbidity and mortality statistics.

139.  It should be remembered that patientsIt should be remembered that patients
understanding of the modalities of care isunderstanding of the modalities of care is
basic to cooperative actionbasic to cooperative action
 The duration of a normal pregnancy isThe duration of a normal pregnancy is
266 – 280 days, or 38 – 42 weeks266 – 280 days, or 38 – 42 weeks
(average is 40 weeks), or 9 calendar(average is 40 weeks), or 9 calendar
months or 10 lunar months.months or 10 lunar months.
 Any baby born before the 39Any baby born before the 39thth
week ofweek of
gestation is called pre-term and a babygestation is called pre-term and a baby
born after the 42born after the 42ndnd
week of gestation isweek of gestation is
said to be post termsaid to be post term

140. DIAGNOSIS OFDIAGNOSIS OF
PREGNANCYPREGNANCY
 URINE EXAMINATION – HCG in theURINE EXAMINATION – HCG in the
urine is the basis for pregnancy tests.urine is the basis for pregnancy tests.
 Present from the 40Present from the 40thth
day through theday through the
100100thth
day reaching a peak level on the 60day reaching a peak level on the 60thth
dayday
 HCG therefore is most correct 6 weeksHCG therefore is most correct 6 weeks
after the last menstrual periodafter the last menstrual period

141. Components of PrenatalComponents of Prenatal
visitvisit
 HISTORY TAKINGHISTORY TAKING
 PERSONAL DATA – patients name, agePERSONAL DATA – patients name, age
address, civil status, family history,address, civil status, family history,
religion, occupation,educationalreligion, occupation,educational
backgroundbackground
 With whom does she lives? Are thereWith whom does she lives? Are there
familial disease that could affectfamilial disease that could affect
pregnancypregnancy

142. OBSTETRICALOBSTETRICAL
ASSESSMENTASSESSMENT
 GESTATIONGESTATION
 Time until the estimated date of confinement orTime until the estimated date of confinement or
estimated date of deliveryestimated date of delivery
 About 280 daysAbout 280 days
 Nagele’s rule for estimating the date ofNagele’s rule for estimating the date of
confinement. This requires that the womanconfinement. This requires that the woman
have a regular 28have a regular 28thth
day menstrual cycleday menstrual cycle
 Add 7 days to the 1Add 7 days to the 1stst
menstrual period, subtractmenstrual period, subtract
3 months, and then add 1 year to the date3 months, and then add 1 year to the date

143. Gravidity and ParityGravidity and Parity
 GravidityGravidity
 GravidaGravida refers to a pregnant womanrefers to a pregnant woman
 GravidityGravidity refers to the number of pregnancyrefers to the number of pregnancy
 NulligravidaNulligravida is a woman who has neveris a woman who has never
been pregnantbeen pregnant
 PrimigravidaPrimigravida is a woman who is pregnant foris a woman who is pregnant for
the first timethe first time
 MultigravidaMultigravida is a woman in at least heris a woman in at least her
second pregnancysecond pregnancy

144. PARITYPARITY
 Is the number of births (not the number ofIs the number of births (not the number of
fetuses, e.g., twins) past 20 weeks of gestation,fetuses, e.g., twins) past 20 weeks of gestation,
whether the fetus was born alive or notwhether the fetus was born alive or not
 NulliparaNullipara is a woman who has not had a birthis a woman who has not had a birth
at more than 20 weeks of gestationat more than 20 weeks of gestation
 PrimiparaPrimipara is a woman who has had one birthis a woman who has had one birth
that occurs after the 20that occurs after the 20thth
week of gestationweek of gestation
 MultiparaMultipara is a woman who has had two oris a woman who has had two or
more pregnancies resulting in viable offspringmore pregnancies resulting in viable offspring

145. Use of GTPALUse of GTPAL
 G is gravidity, the number of pregnanciesG is gravidity, the number of pregnancies
 T is term births, the number born atT is term births, the number born at
births(40 weeks)births(40 weeks)
 P is preterm births, the number bornP is preterm births, the number born
before 40 weeks’ gestationbefore 40 weeks’ gestation
 A is abortions/miscarriages, the numberA is abortions/miscarriages, the number
of abortions and miscarriagesof abortions and miscarriages
 L is live births, the number of live birthsL is live births, the number of live births
or living childrenor living children

146.  Example: A woman is pregnant for the fourthExample: A woman is pregnant for the fourth
time. She had one elective abortion in the firsttime. She had one elective abortion in the first
trimester, a daughter who was born at 40trimester, a daughter who was born at 40
weeks gestation, and a son who was born atweeks gestation, and a son who was born at
36 weeks gestation.36 weeks gestation.
 What is the GTPAL?What is the GTPAL?
 Viability – the ability of the fetus to live outsideViability – the ability of the fetus to live outside
the uterus at the earliest possible gestationalthe uterus at the earliest possible gestational
age.age.
 Age of viability: 20 – 24 weeks (5 – 6 months)Age of viability: 20 – 24 weeks (5 – 6 months)

147. BASELINE DATABASELINE DATA
 Vital signVital sign
 Rollover test – mother will be place onRollover test – mother will be place on
sidelying position for 10 – 15 minutes,sidelying position for 10 – 15 minutes,
until BP is stable. Then mother is place inuntil BP is stable. Then mother is place in
supine, then take BP immediately,supine, then take BP immediately,
systolic >30mmHg, Diastolic > 15mmHgsystolic >30mmHg, Diastolic > 15mmHg

148. Weight MonitoringWeight Monitoring
 First Trimester: Normal Weight Gain 1.5First Trimester: Normal Weight Gain 1.5
– 3 lbs (1 lbs/month)– 3 lbs (1 lbs/month)
 Second Trimester: Normal Weight GainSecond Trimester: Normal Weight Gain
10 – 12 lbs (4lbs/month)10 – 12 lbs (4lbs/month)
 Third Trimester: Normal Weight Gain 10Third Trimester: Normal Weight Gain 10
– 12lbs (4lbs/month)– 12lbs (4lbs/month)

149. Important EstimatesImportant Estimates
 Mc Donald’s Rule – to determine age ofMc Donald’s Rule – to determine age of
gestationgestation
 From symphysis pubis to fundusFrom symphysis pubis to fundus
 Fundic height in cm multiply to 7/8 =Fundic height in cm multiply to 7/8 =
AOGAOG
 Bartholomew’s Rule – to determine ageBartholomew’s Rule – to determine age
of gestationof gestation
 Haases Rule – to determine length ofHaases Rule – to determine length of
fetus in cm ( 1fetus in cm ( 1stst
half of pregnancy: monthhalf of pregnancy: month
times 2, 2times 2, 2ndnd
half: month times 5)half: month times 5)

150. Physical ExaminationPhysical Examination
 Danger signs of pregnancy:Danger signs of pregnancy:
 C – hills and fever, cerebral disturbancesC – hills and fever, cerebral disturbances
 A – bdominal pain: epigastric painA – bdominal pain: epigastric pain
(impending convulsion)(impending convulsion)
 B – oard like abdomen (Abruptio placenta)B – oard like abdomen (Abruptio placenta)
 B – P elevatedB – P elevated
 B – lurred visionB – lurred vision
 S – welling, scotoma, sudden gush of fluidsS – welling, scotoma, sudden gush of fluids