c
 


  
Reproductive system


 ± increase in size that at the end of pregnancy can achieve 500-1000 times greater
capacity
- Body of the uterus at term weigh 1,100g compared to 70g in non pregnant.
- The enlargement of the uterus is not symmetrical and is most masked in the fundus

- Rapid growth of tissue is correlated to synthesis of Polyamines

o Spermadine
o Spermine
o Putrescine
- the relaxed uterus transiently become firm and relax again called Braxton Hicks Contraction
which are common on the last 2 week



1. Softening, cyanosis
- Factors responsible for softening and cyanosis
o Increase vascularity
o Cervical edema
o Hypertrophy and Hyperplasia
2. Mucous Plug ± expelled at the onset of labor
3. Cervical Erosion ± the eating out or ulceration of covering epithelium
4. Fragmentary Crystallization or beady of cervical mucous that is spread and dried on a glass
slide
5. Arborization of crystals or ferming pallor

 
 


- secretion of relaxin
- luteoma of pregnancy ± exaggerated luteinization reaction
- Decidual reaction on and beneath the surface of the ovaries
- Decidual reaction of oviduct


 


- increase vascularity and hyperemia in the skin and muscles of the vulva and perineum
- Chadwick Sign ± the violet color of vagina during pregnancy
- Vaginal secretion is thick white discharge with acidic pH 3.5- 6 due to increase lactic acid
production from glycogen acted by bacteria- Lactobacillus Acidophilus


  
- Striae gravida ± glistening silver lines
- Diastasis recti ± separation of the abdominal muscle due to severe tension
- Pigmentation
a. Linea Nigra ± brownish black
b. Chloasma or mask of pregnancy (Melasma Gravidarum)±irregular brownish patches on the
face and neck
- Cutaneous Vascular changes ± Vascular spiders are angiomas which are minute red elevation
on the skin with radicles branching out from central bodies (ace, neck, upper chest etc)

˜ 
± tenderness and tingling of the breast

- increase in size
- becomes nodular
- colostrums discharge
- glands (follicles) of Montgomery ± hypertrophic sebaceous glands

c

  
1. ±


- average total weight gain ± 24lbs or 11kgs
- average term fetus ± 7 ½ lbs
- average weight of placenta and membrane 1 ½ lbs
- amniotic fluid ± 2lbs
- uterus 2 ½
2. 
      
 ± edema associated with pre eclampsia and eclampsia
3. 
 

- pregnancy diabetogeine
- diabetes is aggravated due to progesterone, estrogen and cortisol
4 

- plasma lipids increase
- involves the total lipids ± tryglycerides, lipoprotein and diol
5. 
  
 ± calcium and magnesium decrease cramps experience on 6-8months

 
  

Heart ± increase rate
Heart sounds- splitting of the first heart sound
Heart murmur ±systolic murmur in 90%

 



- increase arterial pressure
- increase vascular resistance
- increase cardiac output until 32-34 weeks AOG





- posture affects arterial blood pressure
- highest when sitting
- lowest when lying and in lateral recumbent position
- any sustained rise of 30mmHg systolic and 15mmHg systolic is indicative of abnormality
- most likely pregnancy induced HPN



 

- diaphragm rises 4cm during pregnancy
- diaphragmatic excursion is greater during pregnancy
- increase tidal volumeincrease minute ventilatory volume
- increase minute oxygen uptake
- decrease functional residual volume
- decrease average residual volume
- decrease total pulmonary resistance
- all improves oxygen saturation in blood


 
- increase size of kidney
- increase GFR adrenal plasma flow due to placental lactogen
- increase water and sodium retention results to edema
- decrease plasma creatinine and urea due to increase GFR
- there is glucosuria (physiologic) due to increase GFR and increase food intake
- There is no proteinuria not unless pre-eclampsia develops

  ± displacement of internal organ especially appendix

- Decrease tone and motility of GI tract
- Progesterone cause smooth muscle relaxation
- Heartburn (pyrosis) is common
- Hemorrhoids secondary to constipation

!
 ± increase in size
- increase alkaline phosphates due to isozymes from placenta
- decrease plasma albumin circulation
- spider nevi and palmar erythema similar to liver disease is common

 ˜  ± prone to gall stone formation

"
 ± increase pituitary gland size due to estrogen action
- HPL increase pituitary GIT is decreased
- Increase in prolactin especially on the last 5weeks of pregnancy
- Moderate enlargement of thyroid due to hyperplasia; increase basal metabolic rate
- Increase thyroxine level

 

 - increase parathormones
- increase calcitonin level

  
- aldosterone increase to afford protector from natiuretic effect of progesterone

c#

- lordosis due to increase weight on the anterior body
- aching, numbness and weakness

$

%  
3 classifications or group of Signs of Pregnancy
1. Positive Sign
2. Probable Sign
3. Presumptive Sign






1. Identification of fetal heart action
2. Perception of fetal movement
3. recognition of fetus radiographically or embryo sonography



%


%&
' 



- by auscultation ± 17-19 weeks AOG
- Hgb ± 120-160 normal
- Site/location of FHR depends on the position of the fetus

$ 

 ± to detect action of fetal heart by 10th ± 12th week
Endocardiogram ± detect FHR as early as 48 days
Real time Sonography ±early as 2nd month of pregnancy

 


&'(
-tunic umbilical cord soufflé
- uterine soufflé
- sounds 20 to fetal movements
- Maternal pulse
- gurgling gas from maternal intestines



%

&
c

- after 18-20 weeks gestation
- - 1st movement is called quickening

 


%&
)* 
- not valid until after 16th week
- + diagnosis at 20weeks gestation in 1/3 of pregnant women
- + at 24 weeks in ½ of pregnant women

  
- By pulse echo sonography after 5weeks
- Can also detect/ identification of blighted ovum
1. loss of definition of gestational sac
2. unusually small gestational sac
3. absence of echoes emanating from the fetus after 8wks gestation

 
%  
1. Enlargement of abdomen - at 12 weeks, uterus is palpable above symphysis pubis
-less pronounce in nulliparous than in multiparous at
2. changes in size, shape, and consistency of uterus - becomes globular
- Doughy or elastic and softens
- Hagar sign
3. changes in the cervix - soft cervix beginning 6-8weeks
4. Braxton Hicks contraction ± painless contraction at irregular intervals from early part of
pregnancy
5. ballottement ± near mid pregnancy
6. outlining of the fetus
7. endocrine tests ± HCG
- LH immunoassay and slide
- Pregnosticen tube test or UCG test
- Hemagglutuatin inhibition test
- All purpose rapid pregnancy screening test



"
%  
1. cessation of menses
2. changes in breast
3. discoloration of vaginal mucosa
4. increase skin pigmentation and striae
5. symptom like ± nausea and vomiting
- urinary disturbances
- fatigue
- perception of fetal movements
p