CARE OF MOTHER AND CHILD

MODULE 2

2.1 PROCESS OF CONCEPTION AND STAGE OF FETAL DEVELOPMENT

GAMETE – is the male or female reproductive cell that contains half the genetic
material of the organism

Female Gamete: Human Egg (Ovum)

- Reproductive cells that is produced in the ovary.
- The largest cell in the female body
- Contains 23 chromosomes
Haploid Nucleus Contains one copy of each chromosome
Cortical granule releases enzymes during fertilization that
harden the zona pellucida and digest
binding proteins on sperm to prevent
POLYSPERMY** after a sperm cell has
entered the ovum.
Corona radiata An external layer of follicular cells which
provide SUPPORT and
NOURISHMENT to the egg cell.
Zona pellucida/ jelly coat Contains a glycoprotein matrix which
acts as a BARRIER to sperm
entry.

Male Gamete: Human Sperm (Spermatozoa)

- reproductive cells that originate in the testicles
- contains 23 chromosomes
- the smallest cell in the male body
- ejaculation of semen averages 2.5 ml of fluid containing 50 to 200 million
spermatozoa per milliliter or an average of 400 million sperm per ejaculation
Head
Acrosome Contains HYDROLYTIC ENZYMES
which help
PENETRATE the jelly coat.
Nucleus Contains the PATERNAL DNA (this will
combine with maternal
DNA if fertilization is successful).
Centriole Needed by a zygote to divide
Midpiece
Mitochondria Provide the ENERGY (ATP) needed
FOR THE TAIL TO MOVE.
Tail/Flagellum
Axoneme A (microtubule structure) which BENDS
TO FACILITATE
MOVEMENT.

Conception is also referred to as fertilization or impregnation. It is the union of the

sperm and the ovum. This usually occurs in the outer third of a fallopian tube, termed
the ampullar portion.

The period of gestation of the human infant is 38 weeks (about 265 days). These 38
weeks are divided into three stages of unequal length, identified by specific changes
within the developing organism.

Stages of Fetal Development

Pre embryonic First 2 weeks, Sperm and ovum unite,
beginning with forming a zygote.
fertilization
The zygote burrows into the
lining of the uterus.

Embryonic Week 3 All the embryo’s organ

through 8 systems form during the 6-
week period following
implantation.

Fetal From week 8 Growth and Organ

through birth refinement.

THE PROCESS OF CONCEPTION

1. OVULATION
 Each month inside your ovaries, a group of eggs starts to grow in small, fluid-
filled sacs called follicles. Eventually, one mature egg is release from one of
the ovaries, which happens every month.
 An ovum is capable of fertilization for only about 24 hours (48 hours at the
most). After that time, it atrophies and becomes nonfunctional. Because the
functional life of a spermatozoon is also about 48 hours, possibly as long as
72 hours, the total critical time span during which sexual relations must occur
for fertilization to be successful is about 72 hours (48 hours before ovulation
plus 24hours afterward).
2. HORMONES RISE
 The follicle develops into something called the corpus luteum. The corpus
luteum releases a hormone that helps thicken the lining of your uterus,
getting it ready for the egg.
3. THE EGG AND SPERM MEETS AT THE FALLOPIAN TUBE
 The released egg (ovum) is propelled into a nearby fallopian tube through the
combination of peristaltic action of the tube and movements of the cilia along
the length of the tube.
 It is fertilized in the fallopian by a single sperm. If no sperm is around to
fertilize the egg, it moves through the uterus and disintegrates.
ACROSOME REACTION
 It is the final step undergone by the sperm to penetrate the protective layers
of the ovum before fertilization by releasing enzymes to dissolve the ovum’s
membrane (HYALURODINASE – proteolytic enzyme)

4. FERTILIZATION
 Fertilization completes the genetic makeup of the baby, including whether it
will be a girl or boy.
 For fertilization to take place, three events must occur during the encounter of
the spermatozoa and the oocyte:
‒ The sperm cells must migrate between any present cumulus cells and
corona radiate cells.
‒ The sperm cell must attach to and penetrate the zona pellucida (ZONA
REACTION membrane enclosing the ovum & sperm becomes
impenetrable to other sperm)
‒ Finally, the plasma membranes of the ovum and the sperm must fuse.
 Only one spermatozoon can penetrate the cell membrane of the ovum. Once
it penetrates the cell, the cell membrane changes composition to become
impervious to other spermatozoa. An exception to this is the formation of
gestational 7trophoblastic disease in which multiple sperm enter an ovum;
this leads to abnormal zygote formation

FACTORS IMPORTANT TO FERTILIZATION

1. Maturation of the ovum & sperm
2. Motility of the sperm to reach the ovum
3. Ability of the sperm to penetrate the zona pellucida & cell membrane of the ovum
to achieve active fertilization

5. CELL STARTS TO DIVIDE

During this time, mitotic cell division, or cleavage, begins. The first cleavage

occurs at about 24 hours; cleavage divisions continue to occur at a rate of
about one every 22 hours so by the time the zygote reaches the body of the
uterus; it consists of 16 to 50 cells. Over the next 3 or 4 days, large cells
tend to collect at the periphery of the ball, leaving a fluid space surrounding
an inner cell mass. At this stage, the structure is termed a blastocyst. The
cells in the outer ring are trophoblast cells. They are the part of the structure
that will later form the placenta and membranes. The inner cell mass
(embryoblast cells) is the portion of the structure that will form the embryo.
 The fertilized egg leaves the Fallopian tube and enters the uterus 3 to 4 days
after fertilization.
6. IMPLANTATION: MOVING TO THE UTERUS
 It signals the end of the pre-embryonic stage of development. It is the process
by which the fertilized egg attaches to the endometrium (lining tissues of the
uterus) approximately 8 to 10 days after fertilization.
 Some women notice spotting (or slight bleeding) for 1 or 2 days around the
time of implantation. The lining of the uterus gets thicker and the cervix is
sealed by a plug of mucus. It will stay in place until the baby is ready to be
born.
 Implantation usually occurs high in the uterus on the posterior surface. Once
implanted, the zygote is called an embryo.
TROPHOBLASTIC LAYER OF CELLS: CONTACTS THE ENDOMETRIUM
(CHORIONIC VILLI) & DIFFERENTIATES INTO:
CYTOTROPHOBLAST SYNCYTIOTROPHOBLAST,
( LANGHAN’S LAYER): OR THE SYNCYTIAL LAYER
protects the growing embryo and fetus production of various placental
from certain infectious organisms hormones, such as hCG,
disappears between the 20th and 24th somatomammotropin (human placental
week. lactogen [hPL]), estrogen, and
progesterone.

7. PREGNANCY HORMONES
 A hormone called human chorionic gonadotrophin (HCG) is produced by the
cells that will eventually form the placenta. It can be found in the mother's
blood within about a week of conception and is detected in pregnancy tests
done on blood or urine.

8. FETAL DEVELOPMENT
 After implantation in the uterus, some of the cells form the placenta while
others form the embryo. The heartbeat begins during the fifth week of
gestation. At the eighth week the developing embryo is now called a fetus.
The fetus at eight weeks is about ½ inch long and constantly growing.

MILESTONES IN THE PROCESS OF FERTILIZATION

A. PRE FERTILIZATION (Transit of Sperm)
1. Release of the egg during ovulation
2. Capacitation
3. Acrosome reaction
B. FERTILIZATION (Contact between Sperm & Oocyte)
‒ 3 ways of the egg’s response upon sperm’s penetration
1. Cortical & zona reactions – impenetrability of other sperms
2. Resumption of 2nd meiotic division – occurs immediately after entry of 1
sperm
3. Metabolic activation of the egg –post fusion activation; initial cellular &
molecular changes for growth & development associated with
embryogenesis
C. POST FERTILIZATION
1. Sperm’s tail detaches from head & degenerates
2. Male & female nuclei lose their nuclear membranes fuse and intermingle with
their chromosomes forming a zygote.
D. PRE-EMBRYONIC PERIOD – 1st 14 days after conception
CHARACTERISTICS:
1. Rapid cellular multiplication & differentiation
2. Establishment of embryonic membranes
3. Development of primary germ cell layers

2.2 EMBRYONIC AND FETAL STRUCTURES

The placenta and membranes, which will serve as the fetal lungs, kidneys, and
digestive tract in utero as well as help provide protection for the fetus, begin growth in
early pregnancy in coordination with embryo growth.

PREPLACENTAL PHASE
The endometrium is now typically termed the decidua (the Latin word for “falling off”)
because it will be discarded after birth of the child.
DECIDUA BASALIS part of the endometrium that lies directly
under the embryo (or the portion where
the trophoblast cells are establishing
communication with maternal blood
vessels).
DECIDUA CAPSULARIS the portion of the endometrium that
stretches or encapsulates the surface of
the trophoblast

DECIDUA VERA remaining portion of the uterine lining

CHORIONIC VILLI
As early as the 11th or 12th day after fertilization, miniature villi, resembling probing
fingers and termed chorionic villi, reach out from the trophoblast cells into the uterine
endometrium to begin formation of the placenta. Chorionic villi have a central core
consisting of connective tissue and fetal capillaries surrounded by a double layer of
cells, which produce various placental hormones, such as hCG,
somatomammotropin (human placental lactogen [hPL]), estrogen, and progesterone.

PLACENTA
a Fleshy, disk-like organ, 15- 20cm in diameter, 2-3 cm in thickness, weighs 400 -600
grams. It formed through the union of the chorionic villi (fetal) and decidua basalis
(maternal) on the 12th day

FUNCTIONS OF PLACENTA

METABOLIC FUNCTIONS:
Respiratory Renal Gastrointestinal Skin Liver
System System System

Transfer of Excretion Transfer of Detoxification Transmission

gases – of wastes; heat of some of maternal
diffusion drugs & antibodies
Detoxified chemicals
in the
mother’s
liver

A. ENDOCRINE GLAND
 Hormone production: HcG, hPL, progesterone, estrogens
 HcG
‒ first placental hormone
‒ suppress maternal immunologic response so placental tissue is not
detected and
‒ rejected as foreign substance
‒ in male fetus, exerts an effect on the fetal testes to begin production and
maturation of Testosterone

PROGESTERONE
‒ hormone that maintains pregnancy
‒ maintains the endometrial lining of the uterus during pregnancy
‒ reduces the contractility of the uterus during pregnancy, thus preventing
premature labor
 ESTROGEN
‒ contributes to woman’s mammary gland development
‒ stimulates uterine growth

PLACENTAL DEVELOPMENT
 At time of implantation two (2) fetal membranes surround the developing fetus
1. CHORION
2. AMNION
 PURPOSES:
‒ Encloses the fetus and the amniotic fluid
‒ Protects the fetus against ascending bacterial infection.
‒ Woman is prone to develop infection if integrity of the membranes are
destroyed.
 CHORION / CHORIONIC MEMBRANE
‒ Develops from the trophoblast
‒ Originates from the portion of the chorionic villi (Contains the chorionic
villi → Burrows into decidua basalis; Fetal side of the placenta
(CHORION FRONDOSUM – LEAFY CHORION) Contains the major
umbilical blood vessels CHORION LAEVE (BALD CHORION)- Smooth
membrane which degenerates as embryo grows, chorionic villi atrophies
& decidua capsularis stretches
‒ Supports the amniotic membrane
 AMNION / AMNIOTIC MEMBRANE
‒ Inner cell membrane develops from the interior cells of the blastocyst;
smooth glistening thin, tough, and translucent membrane directly
enclosing the fetus and the amniotic fluid.
‒ Covering of the umbilical cord and the chorion on the fetal surface of the
placenta and umbilical cord
‒ Eventually comes in contact with the chorion surrounding the fetus
** The amniotic membrane not only offers support to amniotic fluid but also actually
produces the fluid. In addition, it produces a phospholipid that initiates the formation
of prostaglandins, which can cause uterine contractions and may be the trigger that
initiates labor

AMNIOTIC CAVITY
 Develops between the inner cell mass & outer layer of cells (trophoblast) .
 Fetus floats & moves
 At full term, normally contains from 500ml to 1200ml of liquor amnii or “the
waters”.
 Derives its fluid by diffusion from maternal blood

AMNIOTIC FLUID
 Clear and colorless to straw, slightly yellowish color; non-foul odor. 1 st half of
pregnancy – similar in composition to maternal plasma with a lower protein
concentration
‒ Fetus begins to urinate after the 10th week of pregnancy, fetal urine
contributes to the volume of amniotic fluid
 Late in pregnancy – fetal urine excretion, absorbs amniotic fluid thru GIT by
swallowing fluid
‒ Responsible for absorbing nutrients & O2 from maternal blood stream &
disposing of fetal waste products (CO2)
‒ weekly – 500 -1200 ml from first trimester
‒ 38th week until term
AMNIOTIC FLUID’S Composition:
 98% water and 1-2 % organic & inorganic
 solid particles
 albumin, urea, uric acid, leukocytes, enzymes,
 creatinine, lecithin, sphingomyelin, CHON,
 lanugo, bilirubin, fructose, fat, epithelial cells,
 phospolipids and vernix caseosa.

Oligohydramnios Hydramnios
300 ml (fetal renal abnormalities) 2L (GIT & other malformations)
Associated with poor fetal lung Fetus has a severe malformation of the
development malformations that results CNS or GIT that prevents normal
from compression of fetal parts. ingestion of
amniotic fluid
May occur because the kidneys fail to
develop, urine excretion is blocked, or
placental blood flow is inadequate

AMNIOTIC FLUID’s Functions:

1. Protects the fetus from trauma, blows and pressure by blunting & dispersing the
forces.
2. Allows freedom of movement for symmetrical musculoskeletal system growth
and development; prevents from tangling with the membrane.
3. Acts as an excretion and secretion system; source of oral fluid & repository for
waste.
4. Maintain a constant, even temperature.
5. Protects from infection.
6. Aids in diagnosis of maternal and fetal complications.
7. Aids fetal descent during labor by providing lubrication in the birth canal.
8. During labor, if the membranes are intact, the amniotic fluid protects the fetus
from uterine contractions.
9. It also aids in effacement and dilatation of the cervix
10. Prevents pressure on the cord.

AMNIOTIC FLUID Color’s indications:

 Green tinged or meconium stained amniotic fluid in non-breech presentation =
fetal distress.
 Golden = hemolytic disease such as Rh or ABO incompatibility
 Gray = infection.

YOLK SAC – 8-9 days after implantation

 Membrane surrounding the blastocyst cavity formed on either side of the
developing embryonic disk.
 FUNCTIONS:
1. Helps transfer maternal nutrients & O2 by diffusion through the chorion
(embryo while uteroplacental circulation is being established.
2. Forms early blood cells until hemopoeitic activity begins in the liver

UMBILICAL CORD
 Lifeline (circulatory pathway) linking the embryo & the chorionic villi of the
placenta which extends from the umbilicus to the fetal portion of the placenta
 FUNCTION
1. Transport oxygen and nutrients to the fetus from the placenta and to return
waste products from the fetus to the placenta
 ‒ length at term – 50 - 55 cm , diameter – 2 cm (¾ in), ocation – centrally
 CONTAINS:
1. One vein
‒ carries blood, nourishment & oxygenated blood from the placental villi to
the fetus
2. Two arteries
‒ The amino and the chorion does not have nerve supply and blood vessels
so the mother neither the fetus experience pain when they rupture.
‒ Take waste products from fetus to placenta to be excreted by the mother
‒ Return deoxygenated blood to placenta
3. Wharton's jelly
‒ Transparent, bluish white gelatinous substance (mucopolysaccharide) –
gives the cord body and prevents compression of the blood vessels to
ensure continued nourishment of the embryo-fetus.
‒ A loose connective tissue containing a cushioning material & prostaglandin
vasoconstrictive effect
‒ carries blood, nourishment & oxygenated blood from the placental villi
to the fetus

2.3 ORIGIN AND DEVELOPMENT OF ORGAN SYSTEMS

STEM CELLS (PRIMARY GERM LAYERS

As a fetus grows, body organ systems develop from specific tissue layers called
germ layers.

Ectoderm = Outer layer Mesoderm = Middle Layer Endoderm = Inner

Layer
Ectoderm = Outer layer Bones and muscle tissue, Lining of digestive tract
Mesoderm = Middle cartilage Heart, blood and Lining of trachea,
Layer Endoderm = Inner blood vessels Reproductive bronchi, and lungs
Layer and excretory systems Inner Liver, pancreas
Nervous system layer (connective tissue Thyroid, parathyroid,
including brain, spinal dermis) of skin thymus, urinary
cord and peripheral Lymphatic system, spleen, bladder, urethra, ear
nervous system, pituitary kidneys, adrenal cortex, and canal, and tonsils
gland, nerves, Lining of lining membranes
the mouth, nostrils, and (pericardial, pleural,
anus, sensory epithelium peritoneal).
of the eye, ear, and nose
Epidermis of skin, sweat
glands, hair, nails
Subcutaneous glands,
mammary glands and
tooth enamel.

All organ systems are complete, at least in a rudimentary form, at 8 weeks gestation
(the end of the embryonic period). During this early time of organogenesis (organ
formation), the growing structure is most vulnerable to invasion by teratogens (i.e.,
any factor that affects the fertilized ovum, embryo, or fetus adversely, such as a
teratogenic medicine; an infection such as toxoplasmosis; cigarette smoking; or
alcohol ingestion).
CARDIOVASCULAR SYSTEM
 The cardiovascular system is one of the first systems to become functional in
intrauterine life. Fetal circulation differs from extrauterine circulation because the
fetus derives oxygen and excretes
 carbon dioxide not from gas exchange in the lungs but from exchange in the
placenta.

RESPIRATORY SYSTEM
 At the third week of intrauterine life, the respiratory and digestive tracts exist as a
single tube. By the end of the fourth week, a septum begins to divide the
esophagus from the trachea. At the same time, lung buds appear on the trachea.

Other important respiratory developmental milestones include:

‒ Spontaneous respiratory practice movements begin as early as 3 months
gestation and continue throughout pregnancy.
‒ Specific lung fluid with a low surface tension and low viscosity forms in alveoli to
aid in expansion of the alveoli at birth; it is rapidly absorbed shortly after birth.
‒ The alveolar cells of the lungs forms and excretes a phospholipid substance
called surfactant approximately at the 24th week of pregnancy. This decreases
alveolar surface tension on expiration, preventing alveolar collapse and
improving the infant’s ability to maintain respirations in the outside environment
at birth.

NERVOUS SYSTEM
 The nervous system begins to develop extremely early in pregnancy. All parts of
the brain (cerebrum, cerebellum, pons, and medulla oblongata) form in utero,
although none are completely mature at birth. Brain growth continues at high
levels until 5 or 6 years of age.
‒ Brain waves can be detected on an electroencephalogram (EEG) by the
eighth week.
‒ The eye and inner ear develop as projections of the original neural tube.
‒ By 24 weeks, the ear can respond to sound, and the eyes exhibit a
pupillary reaction, indicating sight is present.
ENDOCRINE SYSTEM
 The function of endocrine organs begins along with neurosystem development.
‒ The fetal pancreas produces insulin needed by the fetus (insulin is one of
the few substances that does not cross the placenta from the mother to
the fetus).
‒ The thyroid and parathyroid glands play vital roles in fetal metabolic
function and calcium balance.
‒ The fetal adrenal glands supply a precursor necessary for estrogen
synthesis by the placenta.
DIGESTIVE SYSTEM
 The digestive tract separates from the respiratory tract at about the fourth week
of intrauterine life and, after that, begins to grow extremely rapidly. Initially solid,
the tract canalizes (hollows out) to become patent. Later in the pregnancy, the
endothelial cells of the gastrointestinal tract proliferate extensively, occluding the
lumen once more, and the tract must canalize again.
 The proliferation of cells shed in the second recanalization forms the basis for
meconium (a collection of cellular wastes, bile, fats, mucoproteins,
mucopolysaccharides, and portions of the vernix caseosa - accumulates in the
intestines as early as the 16th week. Meconium is sticky in consistency and
 appears black or dark green (obtaining its color from bile pigment). An important
neonatal nursing responsibility is recording that a newborn has passed
meconium as this rules out a stricture (noncanalization) of the anus.
MUSCULOSKELETAL SYSTEM
 During the first 2 weeks of fetal life, cartilage prototypes provide position and
support to the fetus. Ossification of this cartilage into bone begins at about the
12th week and continues all through fetal life and into adulthood.

REPRODUCTIVE SYSTEM
 A child’s sex is determined on conception by a spermatozoon carrying an X or a
Y chromosome and can be ascertained as early as 8 weeks by chromosomal
analysis or analysis of fetal cells in the mother’s bloodstream. At about the sixth
week after implantation, the gonads (i.e., ovaries or testes) form.

URINARY SYSTEM
 Rudimentary kidneys are present as early as the end of the fourth week of
intrauterine life, the presence of kidneys does not appear to be essential for life
before birth because the placenta clears the fetus of waste products. Urine,
however, is formed by the 12th week and is excreted into the amniotic fluid by
the 16th week of gestation.

INTEGUMENTARY SYSTEM
 In the earlier weeks of pregnancy, the skin of fetus appears thin and almost
translucent. Approximately at the 36th week of pregnancy, subcutaneous fat
begins to be deposited underneath. Soft lanugo and vernix caseosa cover the
skin, both are still present at birth.

2.4 FERTILIZATION
 Union of the sperm and the ova
1. OVUM – from ovulation to fertilization
2. ZYGOTE – from fertilization to implantation
3. BLASTOCYST – 32 cell stage zygote
4. EMBRYO – from implantation to end of 7 weeks
5. FETUS – from 8 weeks until term
6. CONCEPTUS – developing embryo or fetus and placental structures
throughout pregnancy

IMPLANTATION
HARTMAN’S SIGN
‒ Vaginal bleeding on implantation

PROCESS OF IMPLANTATION
1. APPOSITION – blastocyst brushes against the uterine endometrium
2. ADHESION – blastocyst attaches to the surface of the endometrium
3. INVASION – blastocyst settles down into the endometrium’s soft fold

ORIGIN OF BODY TISSUES:

1. ECTODERM – CNS (brain and spinal cord, PNS, skin, hair and nails Sebaceous
glands, Sense organs, Mucous membrane of the anus, mouth and nose, Tooth
enamel, Mammary glands
2. MESODERM – Supporting structures of the body (connective tissues, bones,
cartillage, ligaments, tendons and muscles), dentin of teeth, Upper portion of
urinary system (kidneys and ureter), reproductive system, heart, Circulatory
system, blood cells, lymph vessels
3. ENDODERM – Lining of pericardial, pleura and peritoneal cavities, lining of GIT,
URT, tonsils, parathyroid, thyroid, thymus, Lower urinary system (bladder and
urethra)
 2.5 MENSTRUATION
A menstrual cycle (the female reproductive cycle) is episodic uterine bleeding in
response to cyclic hormonal changes. During the menstrual cycle, the ovum reaches
its maturity, and a new uterine bed is made ready for the implantation of the fertilized
ova.
CHARACTERISTICS (Silbert-Flagg and Pillitteri, 2018)

Menarche Average age of onset 12.4 years old;

average range of age onset is 9 – 17
years old.
Interval cycles Average interval between cycles is 28
days; 23-35 days is also normal

Duration of Menstrual Flow Average is 4 – 6 days; 2 – 9 days is also

normal

Amount of menstrual flow Average amount of menstrual flow is 30-

80 mL

Color or menstrual cycle Dark red; a combination of blood, mucus

and endometrial cells

FOUR BODY STRUCTURES ARE INVOLVED IN THE PHYSIOLOGY OF THE

MENSTRUAL CYCLE:
1. Hypothalamus,
2. Pituitary Gland
3. Ovaries
4. Uterus

FOUR PHASES OF THE MENSTRUAL CYCLE

1. PROLIFERATIVE – The First Phase of the Menstrual Cycle
2. SECRETORY – The Second Phase of the Menstrual Cycle
3. ISCHEMIC – The Third Phase of the Menstrual Cycle
4. MENSES – The Fourth Phase of the Menstrual Cycle

2.6 DIAGNOSIS OF PREGNANCY

Confirmation of her pregnancy is most important for both the mother and the fetus. It
is then when the woman can begin receiving medical care for the health and welfare
of herself and the baby.

There are three different categories for the signs of pregnancy. The categories are:
1. PRESUMPTIVE – are mainly subjective changes experienced and reported by
the woman.
2. PROBABLE – are objective findings that can be documented by the examiner.
3. POSITIVE – are objective findings that can be documented by the examiner.
A. PRESUMPTIVE (SUBJECTIVE) SYMPTOMS – These are signs of pregnancy
the woman is experiencing that makes her suspicious that she may be pregnant.
They are subjective signs reported by the woman and are not definite that a
baby is growing in the uterus. When symptoms are taken as single entities, it
could easily indicate other conditions.

WEEK FINDING DESCRIPTION

1 Breast changes Tenderness, fullness,
tingling; enlargement &
darkening of areola
2 Nausea & Vomiting Arising when fatigues
2 Amenorrhea Absence of menstruation
3 Frequent Urination Sense of having to void
more often than usual
12 Fatigue Generally feeling of
tiredness
12 Uterine Enlargement Can be palpated at the
symphysis pubis
18 Quickening Fetal movement felt by
woman

24 Linea Nigra Line of dark pigment forms

on the abdomen

24 Melasma Dark pigment forms on

face
24 Striae Gravidarum Red streaks form on
abdomen

B. PROBABLE (OBJECTIVE) FINDINGS – It is objective and so can be verified by

an examiner. Although they are more reliable than presumptive symptoms, they
still do not positively diagnose a pregnancy.

WEEK FINDING DESCRIPTION

1 Maternal serum test Presence of HCG
hormone
6 Chadwick’s sign Color change of vagina
(pink-violet)
6 Goodell’s sign Softening of cervix
6 Hegar’s sign Softening of the lower
uterine segment
6 Sonographic evidence of Characteristic wing is
gestational sac evident

16 Ballottement Fetus can be felt to rise

against the abdominal wall
20 Braxton Hicks Periodic uterine tightening
Contractions

20 Fetal outline felt by Fetal can be palpated

examiner through abdomen
C. POSITIVE FINDINGS – Positive signs of pregnancy are those signs that are
definitely confirmed as a pregnancy.

WEEK FINDING DESCRIPTION

8 Sonographic Evidence of Fetus can be felt to rise
fetal outline against the abdominal wall

10 -12 Fetal Heart Audible Periodic uterine tightening

20 Fetal outline felt by Fetal can be palpated

examiner through abdomen

SIGNS & SYMPTOMS OF PREGNANCY

1. PRESUMPTIVE SIGNS – are mainly subjective changes experienced and
reported by the woman.
‒ Amenorrhea
‒ Breast Changes
‒ Urinary frequency
‒ Quickening
‒ Easy Fatigability
‒ Leukorrhea
‒ Nausea and Vomiting or
‒ Morning sickness
‒ Skin Changes
‒ Abdominal enlargement

2. PROBABLE SIGNS – are objective findings that can be documented by the

examiner.
‒ Hegar’s sign
‒ Uterine growth
‒ Ballottement
‒ Uterine suffle
‒ Goodell’s sign
‒ Braxton- Hick’s contractions
‒ Fetal outline
‒ Positive pregnancy tests
‒ Chadwick’s sign

3. POSITIVE SIGNS – indicates the confirmation of pregnancy.

‒ Fetal heart tone
‒ Funic suffle
‒ Fetal movement felt by the examiner
‒ X-ray visualization of fetal skeleton as early as 14 weeks
‒ Ultrasonographic evidence of pregnancy
 2.7 DISCOMFORT OF PREGNANCY
 Nausea & Vomiting
 Syncope
 Urinary urgency & frequency
 Breast tenderness
 Nasal Congestion
 Fatigue
 Heartburn
 Ankle Edema
 Varicose vein
 Headaches
 Hemorrhoids
 Constipation
 Flatulence
 Leg Cramps
 Shortness of Breath
 Insomnia
 Leukorrhea
 Numbness/tingling of the fingers and/or toes
 Palpitations
 Nosebleeds (epistaxis)
 Pelvic Pressure
 Skin change

2.8 PHYSIOLOGIC CHANGES OF PREGNANCY

A. REPRODUCTIVE SYSTEM CHANGES

1. UTERUS
UTERINE PREPREGNANCY TERM
Weight 50- 70 gm 800-1,200 gm
Capacity 10 ml 5000 ml
Thickness 1- 2 cm 5 cm
Length 6.5 cm 32 cm
Depth 2.5 cm 22 cm
Width 4 cm 24 cm

 PATTERN OF UTERINE GROWTH (location of the fundus)

‒ 12 weeks – at the level of symphysis pubis
‒ 16 weeks – halfway between symphysis pubis and umbilicus
‒ 20 weeks – at the level of the umbilicus
‒ 24 weeks – two fingers above umbilicus
‒ 30 weeks – midway between umbilicus and xiphoid process
‒ 36 weeks – at the level of xiphoid process
‒ 40 weeks – two fingers below umbilicus uterus sinks to a lower level (at
the level of 34 weeks) (lightening)
 UTERINE BLOOD FLOW
‒ Increases from 20 ml before pregnancy to 700- 900 ml at the end of
pregnancy.
‒ Three fourths of blood supply goes to the placenta.
 UTERINE SHAPE
‒ From pear shape before pregnancy to spherical and later on to ovoid
shape in the last months of pregnancy.
‒ Can hold a 7-lb (3,175 g) fetus plus 1,000 ml amniotic fluid = 4000g
 UTERINE POSITION
 ‒ After 12 weeks gestation, the uterus loses its anteflexed position.
 UTERINE CONTRACTILITY
‒ Beginning on the first trimester, the uterus undergo irregular contractions
called Braxton-Hick’s contractions.
‒ Late in pregnancy, contractions become more intense and frequent
causing false labor.
 ISTHMUS
‒ During pregnancy, the isthmus softens and elongates up to 25 mm. It
will later form the lower uterine segment, together with the cervix.
‒ Hegar’s sign – softening of the lower uterine segment that begins as
early as 6 weeks gestation.
‒ 2 weeks before the term (the 38th week) pregnancy, lightening occur
(primipara).(for multipara, not predictable)
‒ 16th to 20th week of pregnancy, when the fetus is still small in relation
to the amount of amniotic fluid present, ballotement may be
demonstrated
‒ Braxton-hicks contraction – “practice contraction”
2. CERVIX
 LEUKORRHEA
‒ Estrogen stimulation results in increase mucus production that leads to
the formation of Operculum, the mucus plug of the cervix that protects
against bacteria and infection.
‒ The discharge of Operculum at term, called Show, is an important sign
of labor.
 CONSISTENCY
‒ Goodell’s sign, is observable by 6 to 8 weeks gestation.
3. VAGINA AND VULVA
‒ Chadwick’s sign – vaginal mucosa change in color from pinkish to
‒ purplish or dark-bluish.
‒ Vaginal pH: 3.5 to 6, Acidic
4. OVARIES
‒ Upon conception, the major function of the corpus luteum is to
‒ secrete progesterone for the first 6- 12 weeks of gestation. During
‒ pregnancy ovulation ceases
5. BREASTS
‒ Increased breast size due to alveolar tissue growth, fat deposition and
increased vascularity: Nipples increase in size and become more erect
‒ Areolae become larger and more pigmented.
‒ Montgomery tubercles become more prominent and secrete a substance
that lubricates the nipples.
‒ Colostrum, a thick, yellow breast fluid, is present beginning in the
second trimester and can readily be expressed by the third trimester.
B. CARDIOVASCULAR

1. HEART
 SIZE AND POSITION
‒ Muscles of the heart enlarge slightly because of increased cardiac
workload.
‒ The heart is pushed upward and toward the left as the uterus elevates
the diaphragm during the third trimester.
 HEART SOUNDS – Some heart sounds may be altered that they may be
considered abnormal in a non pregnant state.

The following are normal during pregnancy:

a. Splitting 3rd sound is due to lowered blood viscosity.
b. Systolic murmurs in about 90% of pregnant women
c. Diastolic murmur in 20%
d. Benign pericardial effusion on x-ray

2. BLOOD AND PLASMA VOLUME

‒ Total blood volume increases about 40 % to 50 % during pregnancy
‒ Plasma volume begins to increase at 6- 8 weeks of gestation and peaks at
4,700 to 5,200 mL at 32 weeks, the concentration of hemoglobin and
erythrocytes decreases giving a woman a pseudoanemia.
3. CARDIAC OUTPUT
‒ Rises rapidly during the first trimester and increases 30% to 50% by third
trimester.
‒ Heart rate rises 10 to 20 beats per minute by 32 weeks of gestation.
‒ Cardiac output is highest when the woman is lying on her side and lower in
the sitting, standing, or supine position.
4. PERIPHERAL VASCULAR RESISTANCE AND BLOOD PRESSURE
‒ PVR falls during pregnancy.
‒ BP remains stable during pregnancy despite the increase in blood volume.
Diastolic pressure shows a decrease (about 10 to 15 mm Hg) that is greatest
at 24 to 32 weeks of gestation. Bp returns to usual levels by term.
5. SUPINE HYPOTENSION SYNDROME
‒ Caused by the pressure of the gravid uterus to the vena cava against the
vertebrae, obstructing blood flow from the lower extremities.
‒ Can lead to fetal hypoxia
‒ The woman experiences lightheadedness, faintness, palpitations.
‒ Left side lying position is the preferred position.
6. BLOOD CONSTITUTION
‒ Fibrinogen increases by 50% (necessary for clotting), because of the increase
level of estrogen.
‒ Platelet count, Factors VII, VIII, IX, and X are also increase.
‒ WBC increases

C. RESPIRATORY SYSTEM
 Changes are caused by:
‒ Increased oxygen requirements
‒ Effect of progesterone and estrogen
‒ Mechanical effect of the enlarging uterus that educes the space in the
chest
‒ Hyperventilation is experienced in an effort to blow off the extra carbon
dioxide from the fetus.
‒ Nasal congestion occurs due to estrogen stimulation.

D. URINARY SYSTEM
 Urinary frequency is due to:
‒ FIRST TRIMESTER – uterus exerts pressures on the bladder as it rises
out of the pelvic cavity
‒ SECOND TRIMESTER – pressures of the presenting part on the
bladder after lightening
‒ Increased blood flow to the kidney which increases GFR and
consequently, UO.
‒ LACTOSURIA – Lactose is secreted by the mammary glands but since
it is not yet used during pregnancy, it normally spills in the urine.

The following are increased during pregnancy:

a. Increased UO as the mother must excrete her metabolic waste products and
those of the fetus too. With increased volume of urine, specific gravity decreases.
b. GFR and renal plasma flow by 40 %
c. Kidney increases slightly in size
d. Greater loss of amino acids and water soluble vitamins in the urine of pregnant
woman.

E. GASTROINTESTINAL SYSTEM

1. NAUSEA AND VOMITING (First Trimester) :

‒ increased HCG and estrogen levels
‒ Decreased maternal glucose levels as glucose is being utilized for fetal brain
development.
‒ EFFECTS OF PROGESTERONE:
1. CONSTIPATION – decreased GIT motility and longer emptying time.
2. PYROSIS/ HEARTBURN – relaxation of cardiac sphincter results in
reflux of acidic gastric contents into the lower esophagus which irritates
the esophageal mucosa.
3. Generalized itching and increased predisposition to gall stone formation
due to slowed bile movement from gall bladder resulting to reabsorption
of bilirubin into maternal blood stream.
‒ EFFECTS OF ESTROGEN :
1. PTYALISM – increased salivation
2. EPULIS – hypertrophy or swelling of gums

F. INTEGUMENTARY SYSTEM
Increased melanin production:
1. MELASMA – Facial dicoloration
2. LINEA NIGRA – dark line from umbilicus to symphysis pubis
3. DARKER AREOLA
‒ ESTROGEN EFFECTS:
1. Palmar erythema – redness and itching of the hands
2. Vascular Spider Nevi – prominent capillaries under the skin
3. Activation of sweat and sebaceous glands resulting in increased
perspiration and oily skin
4. Striae Gravidarum- enlargement of the uterus results in stretching and
tearing of the elastic fibers of the abdominal skin, that results to striae.
5. They appear pinkish during pregnancy and turn silvery white after
delivery.
6. Pruritus or severe itching of the abdominal skin is due to the stretching
of the skin.

G. ENDOCRINE SYSTEM
 THYROID GLAND – slight enlargement of thyroid gland due to increased
metabolic rate
 PANCREAS – Elevated glucocorticoid levels stimulate increase in insulin
production
 PARATHYROID GLANDS – enlargement of parathyroid glands to meet the
increased need for Calcium to be utilized for the development of fetal bones
and teeth.
 ADRENAL GLAND – increased corticosteroid production and aldosterone
production promote sodium reabsorption and water retention.
 High estrogen levels inhibit LH and FSH production
 Increased secretion of growth hormone and melanocyte stimulating hormone
  Posterior Pituitary gland secrete increasing amounts of oxytocin and prolactin
as pregnancy nears term
 ESTROGEN EFFECTS:
‒ Hormone for Women
‒ Stimulates uterine growth
‒ Increases blood supply to uterine vessels
‒ Increases uterine contraction near term
‒ Aiding in the development of the glands and ductal system in the breasts
in preparation for lactation
‒ Causing hyperpigmentation, vascular changes in the skin, increased
salivary gland activity, and hyperemia of gums and nasal mucous
membranes
 PROGESTERONE EFFECTS:
‒ Hormone of Pregnancy
‒ Maintaining the endometrial layer for implantation of the fertilized ovum
‒ Preventing spontaneous abortion by relaxing the smooth muscles of the
uterus
‒ Helping to prevent tissue rejection of the fetus
‒ Stimulating the development of lobes and lobules in the breast in
preparation for lactation.
‒ Facilitating the deposit of maternal fat stores, which provide a reserve
energy for pregnancy and lactation.

H. SKELETAL SYSTEM
 Softening of joints and ligaments, especially of symphysis and sacroiliac joints
is caused by relaxin and estrogen causing a woman a waddling gait.
 Leg cramps is caused by pressure of gravid uterus on nerves and imbalance
of calcium in the body.
 Emotional Responses to Pregnancy
‒ Ambivalence
‒ Grief
‒ Narcissism (self-centeredness)
‒ Introversion vs Extroversion
‒ Body image and boundary
‒ Stress
‒ Emotional lability
‒ Couvade syndrome

2.9 PSYCHOLOGIC CHANGES OF PREGNANCY

FIRST TRIMESTER UNCERTAINTY
 Early weeks - unsure - pregnant and tries to
confirm it.
 Observes her body for changes
 Reaction uncertainty of pregnancy
‒ Eagerness : pregnant or not

AMBIVALENCE
 Conflicting feelings, or ambivalence, about being
pregnant.
 Examine the meaning of the pregnancy in terms of
changes that must be made in their lives and what
they must give up as a result of the pregnancy.
THE SELF AS PRIMARY FOCUS
 Because she has not gained weight to confirm a
growing, developing fetus, she probably says “I am
 pregnant” rather than “I am going to have a baby”
 Physical changes and increase hormone levels
may cause emotional lability (unstable moods).

SECOND TRIMESTER PHYSICAL EVIDENCE OF PREGNANCY

 Physical changes occur in expectant mother that
make the fetus “real”.
‒ Uterus grows rapidly and can be palpated in the
abdomen, weight increases, and breast
changes are obvious.
‒ (Quickening), which confirms that a life is
developing within the uterus. Now she might
say “I am going to have a baby”.

THE FETUS AS PRIMARY FOCUS

 The discomfort of the first trimester has usually
abated and her size does not alter her activity.
 Now concern about producing healthy infant.
NARCISSISM’S AND INTROVERSION
 Increasingly concern about their ability to protect
and provide for the fetus.
 The primigravida wonders about the infant.
‒ Looks at baby pictures of herself and her
partner and wants to hear stories about
themselves as infants.
‒ Multiparas interested in infant and concerned
with child’s acceptance by sibling and
grandparents.
BODY IMAGE
 Rapid and profound changes take place in the
body during second trimester.
CHANGES IN SEXUALITY
THIRD TRIMESTER VULNERABILITY
 The sense of well-being and contentment that
dominates the second trimester gives way to
increasing feelings or vulnerability, particularly
during the seventh month of pregnancy.
 Many mothers have fantasies or nightmares about
harm coming to the infant and become very
cautious as a result.
INCREASING DEPENDENCE
 Dependent on partner in the last weeks of
pregnancy.
‒ Need for love and attention from her partner -
more pronounced in late
PREPARATION FOR BIRTH
 Feelings of vulnerability decreased as the woman
comes to terms with her situation.
 Are concerned - ability to determine when they are
in labor. During this trimester an expectant mother
may say “I am going to be a mother” as she
prepares for the infant.
3 DEVELOPMENTAL TASKS: BY RUBIN
A. FIRST TRIMESTER: ACCEPTANCE OF PREGNANCY
‒ Phase I: Woman accepts the biological fact of pregnancy; able to state “ I am
pregnant” and incorporate the idea of a child into her body and self image
( fetus as an real ).
B. SECOND TRIMESTER: ACCEPTANCE OF THE FETUS AS A SEPARATE
INDIVIDUAL
‒ Phase II: Accept the growing fetus ask distinct from the self as a person to
nurture; can say” I am going to have a baby” at second trimester beginning
of mother- child relationship; becomes more introspective and enters a quiet
period.
C. THIRD TRIMESTER: ACCEPTANCE OF MOTHERHOOD
‒ Phase III: Prepare realistically for birth and parenting of the child; expresses
“ I am going to be a mother “, defines the nature and characteristics of the
child.

2.10 GENERAL HEALTH MAINTENANCE

SCHEDULE OF CLINIC VISIT
 Should begin as soon as possible after the first missed period. Subsequent clinic
visit for normal pregnancy are scheduled as follows:
‒ From first visit to 32 weeks – every 4 weeks
‒ From 32 weeks to 36 weeks – every 2 weeks
‒ From 36 weeks until delivery – every week

EXERCISE
 Recommended exercise during pregnancy:
1. PELVIC ROCKING – relieves low backache; strengthen the muscles of the
lower back
2. SQUATTING AND TAILOR SITTING – stretch and strengthen perineal
muscles; improve circulation in the perineum
3. RIB CAGE LIFTING – relieves shortness of breath
4. CALF STRETCHING – relieves leg cramps
5. SHOULDER CIRCLING – relieve upper backache and numbness of arms
and fingers
6. ABDOMINAL MUSCLE CONTRACTIONS – strengthen abdominal muscles
in preparation for labor pushing
7. MODIFIED KNEE CHEST – relieve hemorrhoids, vulvar varicosities and low
backache
8. LEG ELEVATION – relieve swelling, fatigue, varicosities of lower extremities
9. LEG RAISING – relieve swelling, fatigue, varicosities of lower extremities
10.KEGEL EXERCISE – strengthen perineal muscles

CLOTHING
 Characteristic of good maternity clothes:
a. Light weight,non constrictive and loose fitting
b. Absorbent and washable because of increased perspiration
c. Reasonably priced because they will be used only during pregnancy.
‒ Advise the woman to avoid using constricting garters around the legs,
abdomen and breasts.
‒ Flat heeled shoes that provide good support are recommended during
pregnancy.

BATHING
1. Encourage daily baths
2. Tub baths are discouraged
3. It is alright for the pregnant woman to go swimming but Not diving
4. Bathing is contraindicated when there is vaginal bleeding and after membranes
have ruptured

BREAST CARE
1. Well fitted and larger sized brassiere is recommended for the increased breast
mass and pendulous breast. Bras should provide adequate support, with
zprevent loss of breast tone.
2. If woman plans to breastfeed, nipple rolling between thumb and forefinger and
drying of nipples with rough towel is encouraged to help toughen the nipple.
3. Wash breast with water only.

IMMUNIZATIONS
1. Immunizations with vaccines containing live viruses is contraindicated. Example
of these vaccines are: Measles (Rubella), Sabin (Oral) poliomyelitis, Mumps
2. Hepa B vaccine is given only if risk factors are present. Typhoid vaccine and
plague vaccine is given if there is possibility of exposure or if the woman will
travel to endemic areas.
3. The immunization recommended to all pregnant women in the Philippines is
Tetanus Toxoid vaccine given in the following schedule:
‒ TT1 – anytime during pregnancy (usually on the second trimester)
‒ TT2 – One month after TT1
‒ TT3 – six months after TT2
‒ TT4 – one year after TT3
‒ TT5 – one year after TT4

EMPLOYMENT
1. Pregnant women can continue working as long as their job does not compromise
the woman’s safety
2. Studies have shown that continued employment during pregnancy resulted in
low birth weight infants

TRAVEL
 There is usually no travel restrictions during pregnancy but it is advised that
pregnant women avoid long trips on the third trimester.
 The best time to travel is on the second trimester because the woman is most
comfortable at this time and there is minimum danger of abortion and preterm
labor.
 When Traveling:
‒ A 15 to 20 minute rest period every 2 hours on long rides to move about and
empty bladder
‒ Use of shoulder and lap belts should be emphasized for safety
‒ The place should be pressurized, exposure to low oxygen concentration at
high altitudes when traveling by non- pressurized plane can cause fetal brain
damage

SEXUAL RELATIONS
 Sexual desires continue during pregnancy but sexual drive and responsiveness
vary among women at different stages of pregnancy:
‒ First Trimester – decreased sexual desire due to discomforts of pregnancy or
due to preoccupation to the changes occurring in her body.
‒ Second Trimester – Increased sexual desire because the woman has already
adjusted to pregnancy and this is the period when she is most comfortable.
 ‒ Third Trimester – decreased sexual desire because of the fear of hurting the
fetus and the discomfort caused by enlarged abdomen and deep penile
penetration.
 Contraindications to sexual intercourse: Deeply presenting part, rupture bag of
water, vaginal spotting or bleeding, incompetent cervical os
 During the last 6 weeks of pregnancy, coitus is discouraged by some physicians
because it has been related to increased incidence of postpartal infection,
preterm labor, premature rupture of membrane and bleeding.

ALCOHOL AND SMOKING

 Alcohol and smoking are contraindicated during pregnancy
 Effects of alcohol are abortion and prematurity.
 Nicotine present in cigarettes causes vasoconstriction resulting in decreased
blood flow to the placenta which in turn, diminishes oxygen supply to the fetus.
Fetal hypoxia leads to low birth weight.
 Smoking affects the appetite of the mother resulting in decreased caloric intake
which in turn leads to limited maternal weight gain.

2.11 EDD/AOG
DETERMINING GRAVIDITY & PARITY
 GRAVIDITY – number of pregnancies regardless of outcome
 PARITY – defined as the number of times that she has given birth to a fetus with
a gestational age of 20 weeks or more, regardless of whether the child was born
or was stillborn.
 GRAVIDA – is the no. of pregnancies regardless of duration or outcomes.
‒ A GRAVIDA (G) woman is a woman who is pregnant (present) now has been
pregnant(past) , irrespective of the outcome of pregnancy.
‒ A NULLIGRAVIDA (Go) is a woman who: Is not pregnant now, has never
been pregnant

PRINCIPLES IN IDENTIFYING PARITY

1. The no. of pregnancies is counted and not the no. of fetuses
‒ Ex. Cynthia is pregnant for the first time and is carrying twins. She is
presently G1P0. At 37-38 weeks, Cynthia delivered to monozygotic twins
making her G1P1.
2. Abortion is not included in parity count because the fetus is delivered before the
age of viability (before 20 weeks). Parity will include all pregnancies beyond the
age of viability
‒ Ex. Sussie is pregnant for the second time. Her first pregnancy 3 years ago
ended in an abortion. Sussie is presently G2P0. After delivery of a preterm
or a full term baby, Sussie will be designated G2P1.
3. Live birth or still birth is counted in parity count whether the fetus is born alive or
still, for as long as it has reached 20 weeks, it is counted as one parity.
‒ Ex. Josette is pregnant for the first time (G1P0). After 34 weeks, she
delivered a 4-lb baby boy with no signs of life (stillbirth). This makes Josette
a primipara (G1P1)
 A NULLIPARA is a woman who had not carried a pregnancy beyond 20 weeks
or beyond the period of abortion.
 A PRIMIPARA is a woman who has completed one pregnancy to age of viability
and subsequently delivered the fetus, whether alive or dead at birth.
 A MULTIPARA is a woman who has carried 2 or more pregnancies to stage of
viability and subsequently born alive or dead.
 A GRANDMULTIPARA is a woman who has had 6 or more viable deliveries,
whether, the fetuses were alive or dead.
 A woman who is described as “gravida 2, para 2”or G2P2 has had two
pregnancies and 2 deliveries after 24 weeks
 A woman who is described as “gravida 2, para 0”or G2P0 has had two
pregnancies, neither of which survived to a gestational age of 24 weeks
 If they are both currently pregnant again, these women would have the obstetric
resume of G3P2 and G3P0

OBSTETRICAL SCORING
 TPAL – is one of the methods to provide quick overview of a female’s obstetric
history. Two other methods often used are gravida/para and GPA.
‒ T : number of full term infants born ( infants born at 37 weeks or after)
‒ P: number of preterm infants born ( infants born before 37 weeks)
‒ A: number of spontaneous miscarriage or therapeutic abortions
‒ L: number of living children
‒ M: multiple pregnancies

2.12 EXAMINATIONS IN PREGNANCY

 The traditional regime is monthly from the booking visit to 28 weeks’ gestation,
fortnightly to 36 weeks’ gestation and then weekly until delivery.
 A systematic approach is applied in each visit of the woman. Good
communication is essential; the woman should be able to communicate how she
is feeling and if she has any problems. Her general appearance and demeanour
will notify the recognition of several complaints such as stress, anxiety, concern,
illness, disability or lack of sleep. Careful observation of the woman’s general
appearance, her demeanour and the way she communicates can provide vital
information and should not be overlooked.
 BLOOD PRESSURE – Most antenatal regimes require the woman’s blood
pressure to be taken at each visit to identify signs of hypertension.
 URINALYSIS – This should be tested at booking for the presence of bacteria to
screen for asymptotic bacteriuria. And at subsequent visits the urine should be
tested for the presence of protein.
 Weight
 Fundal height
 Abdominal palpation
 Fetal heart/fetal movements
 Blood tests
 Rhesus
 ULTRASOUND SCANS – Visualization of the fetus to assess fetal wellbeing
using an ultrasound scan
 Non-stress cardiotocography

2.13 LABORATORIES AND DIAGNOSTICS

PRENATAL VISITS
 For a pregnant woman to be counted as provided with 4 prenatal care, the
schedule of prenatal care/visits should be at least:
1. 1ST TRIMESTER – first 3 months (up to 12 weeks or 0-84 days)
2. 2ND TRIMESTER – middle 3 months (13-27 weeks or 85-189 days)
3. 3RD TRIMESTER – last 3 months (28 wks& more or 190 days & more)

URINALYSIS
 A urinalysis is a test of your urine. A urinalysis is used to detect and manage a
wide range of disorders, such as urinary tract infections, pre - eclampsia and
gestational diabetes.
 For example, a urinary tract infection can make urine look cloudy instead of clear.
Presence of protein in urine can be a sign of pre-eclampsia.
 Unusual urinalysis results often require more testing to uncover the source of the
problem.
‒ at least 10 ml of urine is generally sufficient for a routine urinalysis.
 Report laboratory results to the primary care provider.
 Discuss findings of the laboratory test with primary care provider.
 Conduct appropriate follow-up nursing interventions as needed, such as
administering ordered medications and client teaching.

FECALYSIS
 A stool analysis is a series of tests done on a stool (feces) sample to help
diagnose certain conditions affecting the digestive tract. These conditions can
include infection (such as from parasites, viruses, or bacteria), poor nutrient
absorption among pregnant women, or cancer.
 The amount of stool to be sent depends on the purpose for which the specimen
is collected. Usually about 2.5 cm (1 in.) of formed stool or 15 to 30 mL of liquid
stool is adequate.

COMPLETE BLOOD COUNT

 A complete blood count (CBC) is a blood test used to evaluate your overall
health and detect a wide range of disorders, including anemia, infection and
leukemia.
 A complete blood count test measures several components and features of your
blood, including:
‒ Red blood cells, which carry oxygen
‒ White blood cells, which fight infection
‒ Hemoglobin, the oxygen-carrying protein in red blood cells
‒ Hematocrit, the proportion of red blood cells to the fluid component, or plasma,
in your blood
‒ Platelets, which help with blood clotting

HIV
 During pregnancy, HIV can pass through the placenta and infect the fetus.
 During labor and delivery, the baby may be exposed to the virus in the mother’s
blood and other fluids. When a woman goes into labor, the amniotic sac breaks
(her water breaks). Once this occurs, the risk of transmitting HIV to the baby
increases. Most babies who get HIV from their mothers become infected around
the time of delivery.
 Breastfeeding also can transmit the virus to the baby.
BLOOD TYPING
 Blood typing is usually done during the first trimester (up to 12 weeks) or the first
prenatal visit. It is used to determine a pregnant woman's blood group, to
establish whether she is A, B, AB, or O, and whether she is Rh -positive or Rh-
negative. A pregnant woman should know her blood type.
 During pregnancy, problems can occur if you're Rh negative and the baby you're
carrying is Rh positive. Usually, your blood doesn't mix with your baby's blood
during pregnancy. However, a small amount of your baby's blood could come in
contact with your blood during delivery or if you experience bleeding or
abdominal trauma during pregnancy. If you're Rh negative and your baby is Rh
positive, your body might produce proteins called Rh antibodies after exposure
to the baby's red blood cells.

GLUCOSE TOLERANCE TEST

 The glucose tolerance test, also known as the oral glucose tolerance test,
measures your body's response to sugar (glucose). The glucose tolerance test
can be used to screen for type 2 diabetes. More commonly, a modified version of
 the glucose tolerance test is used to diagnose gestational diabetes — a type of
diabetes that develops during pregnancy.
 The glucose tolerance test identifies abnormalities in the way your body handles
glucose after a meal — often before your fasting blood glucose level becomes
abnormal.

PREGNANCY TEST
 A pregnancy test measures a hormone in the body called human chorionic
gonadotropin (HCG).
 HCG is a hormone produced during pregnancy. It appears in the blood and urine
of pregnant women as early as 10 days after conception.
 HCG level should almost double every 48 hours in the beginning of a pregnancy.
HCG level that does not rise appropriately may indicate a problem with your
pregnancy. Problems related to an abnormally rising HCG level include
miscarriage and ectopic (tubal) pregnancy.

IMMUNIZATIONS
 Generally, vaccines that contain killed (inactivated) viruses can be given during
pregnancy. Vaccines that contain live viruses aren't recommended for pregnant
women.
 Two Vaccines Are Routinely Recommended During Pregnancy:
1. Flu (influenza) shot. The flu shot is recommended for women who are
pregnant during flu season — typically November through March. The flu
shot is made from an inactivated virus, so it's safe for both you and your
baby. Avoid the influenza nasal spray vaccine, which is made from a live
virus.
2. Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap)
vaccine. One dose of Tdap vaccine is recommended during each pregnancy
to protect your newborn from whooping cough (pertussis), regardless of
when you had your last Tdap or tetanus-diphtheria (Td) vaccination. Ideally,
the vaccine should be given between 27 and 36 weeks of pregnancy.
 Your health care provider will recommend avoiding vaccines that contain live
viruses during pregnancy because they pose a theoretical risk.
 Examples of vaccines to avoid during pregnancy include:
‒ Chickenpox (varicella) vaccine
‒ Measles-mumps-rubella (MMR) vaccine
‒ Shingles (varicella-zoster) vaccine