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INTRODUCTION

INTRODUCTION. Woman’s reproductive period 13-45 years. Menarche. Menopause. Duration of Pregnancy 9 calendar months and 7 days ; 280 days ; 40 weeks Menstrual or gestational age Fertilization or Ovulatory age. 280 days -14 days=266 days. First trimester: first 12 weeks

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INTRODUCTION

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  1. INTRODUCTION Woman’s reproductive period 13-45 years Menarche Menopause

  2. Duration ofPregnancy 9 calendar months and 7 days ; 280 days ; 40 weeks Menstrual or gestational age Fertilization or Ovulatory age 280 days -14 days=266 days

  3. First trimester: first 12 weeks • Second trimester: 13-28 weeks • Last trimester: 29-40 weeks

  4. First trimester • Subjective Symptoms • Objective Signs • Immunological Tests • Ultra Sonograph Pregnancy Diagnosis

  5. Subjective Symptoms • Amenorrhoea • Cyclic bleeding may last up to 12 weeks • Scanty and short time- placental sign • Confused with pathological bleeding ,such as miscarriage

  6. Morning Sickness Usually appears soon following the missed period; Rarely lasts beyond 3 months

  7. Frequency of micturition • troublesome symptom during 8-12 weeks • enlarged uterus congested the bladder • change in maternal osmoregulation causes increased thirst and polyuria

  8. Breast discomfort • Fullness • Pricking sensation

  9. Fatigue Occur early in pregnancy

  10. Objective Signs • Breast changes • Valuable only in primigravidae • Breast changes are evident between 6-8 weeks • Enlargement with vascular engorgement evidenced by delicate veins • nipple and areola pigmentation • Montgomery’s tubercle are prominent • Colostrum expressed as early as 12th weeks

  11. Per Abdomen Uterus remains a pelvis organ until 12 weeks

  12. Pelvic Changes Jacquemiet’s or Chadwick’ sign Vaginal sign Cervical signs Uterine signs

  13. Chadwick’ sign • bluish discoloration of the cervix, vagina, and labia caused by the hormone estrogen. • It can be observed as early as 6-8 weeks after conception, and its presence is an early sign of pregnancy.

  14. Vaginal sign (Osiander’s sign) • Bluish discolouration of anterior vaginal wall • Vaginal wall soften • Mucoid discharge • Increased pulsation

  15. Cervical sign (Goodell’ sign) Become soft as early as 6th week Non pregnant Pregnant uterus

  16. Uterine sign Size, shape and consistency Piskacek’s sign Asymmetricenlargement of uterus →Symmetric The pregnant uterus feels softand elastic 8th week , cricket ball 12th week, fetal head 6thweek, hen’s egg

  17. Hegar’s sign demonstrated between 6-10 weeks • Upper part of the body of the uterus is enlarged by growing fetus • Lower part of the body of the uterus is empty and extremely soft • The cervix is comparatively firm

  18. The abdominal fingers behind the uterus The abdominal and vaginal fingers seem oppose below the body of uterus Two fingers in the anterior fornix

  19. Palmer’s signRegular and rhythmic uterine contraction elicited during bimanual examination as early as 4-8 wks

  20. Immunological Test

  21. Principle of pregnancy test detection of the antigen of HCG present in the maternal urine or serum • Selection of time 8-10 days after conception • Collection of urine the first voided urine in the morning in a clean container

  22. Ultra Sonography • Gestation sac (GS) can be identified as early as 29-35 days of gestation

  23. There are trans-vaginal and abdominal Ultrasonagraphys. • A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period. • Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week. • Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

  24. 5 menstrual weeks

  25. True and pseudo gestation sac • York sac and fetal pole present in true gestation sac and absent in pseudo gestation sac

  26. Second trimester: 13-28 weeks

  27. Symptoms • General examination • Abdominal examination • Vaginal examination

  28. Symptoms • Nausea, vomiting, frequency of micturition subside • Amenorrhea continues • Quickening: perception of active fetal movement by women (From 18th week) • Progressive enlargement of lower abdomen by the growing uterus

  29. Pigmentation • General examination Chloasma :appear about 24th week

  30. Breast changes: • more enlarged • Secondary areola darkened • Montogomery’s tubercles are prominent and extend to the secondary areola

  31. Abdominal examination • Inspection • Palpation • Auscultation

  32. Inspection • Linea nigra • Striae gravidarum

  33. Palpation • Fundal height increases • Uterus soft and elastic, ovoid in shape • Braxton-Hicks Contraction • Palpation of fetal parts: 20th week • Active fetal movements: 20th week • External ballottement : elicited as early as 20th week

  34. Fundal Height Fundal height is increased with progressive enlargement of the uterus. Duration of pregnancy can be ascertained by noting the height of the uterus.

  35. 16th week: midway between symphysis pubis and umbilicus • 22~24th week: at the level of umbilicus • 28th week: at the junction of the lower 1/3 and upper 2/3 of the distance between the umbilicus and ensiform cartilage

  36. Abnormal Fundal Height • IUGR (intrauterine growth retardation) • Multiple Pregnancy • Polyhydramnios(CNS or Cardiovascular Disfunction) • Oligohydramnios

  37. Braxton-Hicks Contraction In 1872, John Braxton Hicks investigated the later stages of pregnancy and noted that many women felt contractions without being near birth. This process was usually painless but caused women confusion as to whether or not they were going into actual labor

  38. Very early, the uterus undergoes spontaneous contraction • Firmer at one moment and soft at another • Can be excited by rubbing the uterus • Irregular, infrequent, spasmodic, and painess • Near term, frequent with increase in intensity, discomfort • Merge with the labor

  39. Palpation of fetal parts Diagnosis of pregnancy Identify the presentation and position of fetus

  40. Active fetal movements • Positive evidence of pregnancy & live fetus

  41. External ballottement • Be elicited as early as 20th week • Difficult in obese women & scanty liquor amnii By a push to the foetal parts with one hand abdominally and the other hand receiving the impulse

  42. Ascultation

  43. Fetal heart sound • Most conclusive clinical sign • With an ordinary stethscope, it can be detected between 18-20 weeks

  44. Two sounds confused with fetal heart sounds • Uterine souffle • Fetal souffle

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