Changes Ofpregnancy

7/28/2019 Changes Ofpregnancy

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BY

DUMDUMA,R.N.,R.M.


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Pregnancy:


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FIRST TRIMESTER:

(First 12 weeks)

Presumtive symptoms:

- Amenorrhoea

- Morning sickness

- Breast discomfort

- Fatigue.

Sign

Breast changes- nipple and areola become more

pigmented


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Per abdomen:


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Growth of adbomen during prenancy


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Pelvic changes:- Jacquemiers/ chadwicks sign: dusky hue of the vestibule and

anterior vaginal wall visible at about 8th week of pregnancy( d/t

local vascular congestion.pelvic tumour)- Vaginal sign: pulsation felt through the lateral fornics at 8th

week called osianders

- Cervical signs: cervix become soft as early as 6th week(

goodells sign)- Uterine signs: hen eggs( 6th week)

size of cricket ball at 8th week

size of fetal head by 12 week

when implantation is on lateral and asymmetrical enlargement ofthe uterus..PISKACEKS SIGN

- HEGAR SIGN: can be demonstrated between 6-10 weeks, a

little earlier in multiparae


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upper part of the body of the uterus is enlarged by thegrowing fetus, lower part of the body is empty and

extremely soft, the cervix is comparatively firm.


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- palmers sign: Regular and rhythmic uterinecontraction can be elicited during bimanual

examination as early as 4-8 weeks.


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Pregnancy test


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Selection of time: diagnosis of pregnancy by HCG

in maternal serum or urine can be made by 8 t0 11 days after

conception.

Ultrasonography: intra decidual gestational sac is identified as

early as 29-35 days of gestation


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Second tr imester(13-28 weeks):

Symptoms:

- Quickening: 18 week and 2 week earlier in multi.

- Progressive enlargement of the lower abdomen- Chloasma at 24 week

- Breast changes: prominent vein, 20 areola,montgomerys tubercles prominent and extend tosecondary areola

- Colostrum become thick and yellowish by 16th week


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Abdominal examination:

-inspection: linea nigra 20 week
http://en.wikipedia.org/wiki/File:Cesarean_section_scar_and_linea_nigra.JPG


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Striae gravidarum


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- The uterus feelssoft and elastic

- Braxton hicks contraction

- Palpation of fetal parts by 20th week

- Active fetal movement by 20 weeks- External ballottement by 20 week

AUSCULTATION:By stethoscope 18-20 weeks( watch under apillows).

two sound are confused

a. Uterine souffle: soft blowing and systolic murmur, best on

left side. d/t to blood flow through the dilated uterine

vessels

b. Funic or fetal souffle: soft blowing and murmur synchronouswith the fetal heart sounds, d/t rush of blood through the

umbilical arteries.

f


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Vaginal examination: bluish discolouration of the vulva, vagina

and cervix.

a. Internal ballottement: can be elicit between 16-28 weeks. The

fetus is too small B4 16week and too large to displace after 28

weeks.


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Last trimester( 29-40 weeks):

symptoms:

- amenorrhoea, enlargement of abdomen, lightening

38th weeks, frequency of micturition, fetal movement.

Sign:

-uterine shape is cylindrical to spherical by 36th week

- Fundal height- Braxton hicks contraction are more evident

- FHS base on position

DIFFERENTIAL DIAGNOSIS OF PREGNANCY


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DIFFERENTIAL DIAGNOSIS OF PREGNANCY:

- Uterine fibroid

- Cystic ovarian tumour

- Encysted tubercular peritonitis

- Haematometra

- Distended urinary bladder

Pseudocyesis: Pseudocyesis( psychological disorder)is the medical term for a false pregnancy.

Pseudocyesis can cause many of the signs and

symptoms of pregnancy, and often resembles the

condition in every way except for the presence of a

fetus.


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Summary of d iagnos is of p regnancy

Positive signs of pregnancy are those signs that are

definitely confirmed as a pregnancy. They include

- fetal heart sounds,

- ultrasound scanning of the embryo as early as 6th

week,

- palpation of the entire fetus,- palpation of fetal movements,

- x-ray fetal skeleton at 16 week, and actual delivery

of an infant.

- Auscultation of FHS


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Presum pt ive s igns and sym ptomsof pregnancy arethose signs and symptoms that are usually noted by

the patient, which impel her to make an appointment

with a physician. These signs and symptoms are notproof of pregnancy but they will make the physician

and woman suspicious of pregnancy.

- Amenorrhea (Cessation of Menstruation)

- Nausea and Vomiting (Morning Sickness).

- Frequent Urination.

- Breast Changes.

- Vaginal Changes.


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Chadwick's sign. The vaginal walls have taken on a deeper color

caused by the increased vascularity because of increased hormones. It

is noted at the sixth week when associated with pregnancy

Leukorrhea. This is anincrease in the white orslightly gray mucoiddischarge that has a faintmusty odor. It is due tohyperplasia of vaginalepithelial cells of thecervix because ofincreased hormone levelfrom the pregnancy
http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_1/images/Chadwicks_Sign.jpg


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- Skin Changes.- Fatigue. This is a common complaint by most patients during

the first trimester. Fatigue may also be a result of anemia,

infection, emotional stress

P b bl i f th i l


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Probable signs of pregnancy are those signs commonly

noted by the physician upon examination of the

patient. These signs include

- uterine changes,- abdominal changes,

- cervical changes,

- basal body temperature,- positive pregnancy test by physician, and

- fetal palpation

- Changes in shape, size and consistency of the uterus.- Jacquemiers and osianders sign

- Ballottement( e+i)


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Bibl iography

- Dutta page no 60-74

- http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_1/lesson_3_Section_1A.htm

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Changes Ofpregnancy