PRESENTATION

ON

I) SIGNS & SYMPTOMS OF PREGNANCY

II) MINOR AILMENTS IN PREGNANCY

PRESENTED BY :
ABHILASHA VERMA
M.SC.NURSING PREV.
Govt. College Of Nursing ( Jaipur)
( SMS Medical College)
BATCH (2015-2016)

OBJECTIVES OF
PRESENTATION

At the end of presentation students will be:

Able to define pregnancy.
Able to explain signs and symptoms of first trimester.
Able to explain signs and symptoms of second
trimester.
Able to explain signs and symptoms of third
trimester.

DEFINITION OF
PREGNANCY

It is the state of carrying a developing embryo or fetus

within the female body from conception to birth. After
the egg is fertilized by sperm and then implanted in the
lining of the uterus, it develops into placenta and
embryo or fetus.

DURATION OF PREGNANCY
I)

Usually 40 weeks or

II) 280 days or 10 lunar months or

III) 9 months and 7 days, calculated from the first day of last menstrual
period.
)Beginning from the first day of last menstrual period , It is divided into
three trimesters, each lasting three months.
)First trimester ( First 12 weeks)
)Second trimester ( 13-28 weeks)
)Third trimester ( 29-40 weeks)

SIGNS & SYMPTOMS OF

PREGNANCY

FIRST
TRIMESTER
( FIRST 12
WEEKS)

PRESUMPTIVE SIGNS
OR
1
SUBJECTIVE SIGNS

SECOND
TRIMESTER
(13-28
WEEKS)

PROBABLE SIGNS
OR
2
OBJECTIVE SIGNS

THIRD
TRIMESTER
(29-40
WEEKS)

POSITIVE SIGNS

FIRST TRIMESTER
PRESUMPTIVE SIGNS OR
SUBJECTIVE SYMPTOMS

AMENORRHOEA

AMENORRHOEA

INTRODUCTION:
Absence of menstruation in woman of reproductive age.
However, cyclic bleeding may occur up to 12 weeks until
decicua space is obliterated by the fusion of deciduas vera with
deciduas capsularis. (Implantation bleeding/ Placental sign)
Such bleeding is scanty, lasting for shorter duration and
corresponds with date of expected periods.

DIFFERENTIAL DIAGNOSIS:
Extreme weight loss
Emotional or physical stress
Rigorous exercise.
Severe illness
Hypothyroidism
Polycystic ovarian syndrome .

MORNING SICKNESS

INTRODUCTION :
It is present in about 50% cases, mostly during first
pregnancy.
Nausea and vomiting begins about 6 weeks after the last
menstrual period and usually disappears by about 14 weeks.
It is due to the high level of pregnancy hormones.

DIFFERENTIAL DIAGNOSIS:
Hydatiform mole
Choriocarcinoma
Pre-eclampsia

FREQUENCY OF
MICTURITION

It is present during 8-12 week of pregnancy and subside

after 12 weeks.

DIFFERENTIAL DIAGNOSIS:
U.T.I
Vaginitis
Diuretics medications
Over active bladder syndrome
Tumor in pelvis.

BREAST DISCOMFORT

It is present during 6 th week in the form of feeling of :

* Tenderness.

* Tingling.
* Fullness.
* Increase in size.
* Pigmentation of areaola.
* Pricking sensation.
DIFFERENTIAL DIAGNOSIS :
Breast contusion / trauma
Chest trauma
Chest wall injury
Mastitis
Breast abscess
Neoplastic disorder

FATIGUE

It is frequent in early pregnancy and subside around 12-14

weeks of pregnancy with bringing renew energy.
DIFFERENTIAL DIAGNOSIS
Chronic heart disease
Thyroid disease
Chronic anaemia
Liver disease
Inflammatory bowel disease.

FIRST TRIMESTER
PROBABLE SIGNS OR
OBJECTIVE SIGNS

BREAST CHANGES

BREAST CHANGES

These are valuable only in primiparae, compared to

multiparae.
Breast changes are evident between 6-8 weeks.
There is enlargement with vascular engorgement with
delicate veins visible under the skin due to increased blood
supply, making the veins more noticeable.
Nipples and areola (primary) become more pigmented or
darker.
Montgomerys tubercles are prominent.
The thick yellowish secretion (colostrums) can be
expressed as early as 12 th week.

BREAST

CHANGES

PELVIC CHANGES

Jacquemiers or Chadwicks sign:

It is dusky hue of vestibule and anterior vaginal wall visible
at about 8th week of pregnancy. The discoloration is due to
local vascular congestion.

Vaginal sign :
Apart from bluish discoloration of the anterior vaginal
wall, walls become softened, copious amount of nonirritating mucoid discharge appears at 6 th week. There is
increased pulsation felt through the lateral fornices at 8 th
week called Osianders Sign.

Cervical signs :
Cervix becomes soft as early as 6 th week ( Goodells sign),
the pregnant cervix feels like lip of mouth, while in non-

UTERINE CHANGES

A) Size, shape and consistency :

Uterus enlarged to:
size of hens egg at 6 th week
Size of cricket ball at 8 th week
Size of fetal head at 12 th week
Pyriform shape of nonpregnant uterus becomes globular by
12th week
There may be asymmetrical enlargement of uterus if there
is lateral implantation.
( One half is more firm than other half. As pregnancy
advances, symmery is restored, uterus feels soft and elastic)

CONT...

B) Hegars sign:
It is present in two third of cases.
It can be demonstrated between 6-10 weeks.
It is softening and compressibility of the lower segment
of the uterus felt on bimanual examination ( Two fingers
in anterior fornix and abdominal fingers behind uterus).

C) Palmers sign:
Regular rhythmic uterine contraction on bimanual
examination at 4-8 weeks

HEGAR S SIGN

POSITIVE SIGNS
COMMON TO ALL
THREE TRIMESTER

IMMUNOLOGICAL
TESTS

ULTRA
SONOGRAPHY

IMMUNOLOGICAL TESTS
1

SECOND TRIMESTER
SUBJECTIVE SYMPTOMS

AMENORRHOEA

DECREASE MORNING
SICKNESS & URINARY
SYMPTOMS

ENLARGEMENT OF
LOWER ABDOMEN

QUICKENING

SECOND TRIMESTER
OBJECTIVE SYMPTOMS

SKIN SIGNS
* Cholasma

ABDOMINAL
SIGNS

VAGINAL
SIGNS

ABDOMINAL
SKIN

SIGNS

LINEA NIGRA

STRIAE GRAVIDARUM

CHOLASMA GRAVIDARUM

FUNDAL HEIGHT
Pregnancy in
weeks
At 16th week
At 24th week
At 28th week

Fundal Height
Uterus is midway between symphysis
pubis and umbilicus.
At the level of the umbilicus.
At the junction of lower third and
upper two third of the distance
between the umbilicus and ensiform
cartilage.

FETAL HEART SOUND

FETAL HEART SOUND :

FHS is the most conclusive clinical sign of pregnancy.
It can be detected between 18-20 weeks by stethoscope.
The fetal heart rate varies from 110-160 beats/ min.
Two other sounds are confused with FHS. Those are
UTERINE SOUFFLE:
It is soft blowing and systolic murmur heard low down at the
side of uterus, best on left side. This sound is synchronized
with maternal pulse and is due toincrease in blood flow
through dilated uterine vessels.
FETAL SOUFFLE or FUNIC :
It is due to rush of blood through umbilical artries. It is soft,
blowing murmur , synchronized with FHS.

THIRD

SUBJECTIVE
SYMPTOMS

OBJECTIVE

SIGNS

TRIMESTER

SUBJECTIVE SYMPTOMS
i) Amenorrhoea.
ii) Progressive enlargement of abdomen.
iii) Palpitation and dysponea following exertion due to
enlarge abdomen.
iv) Lightening: At about 38 week, sense of relief of
pressure symptoms obtained due to engagement of
presenting part.
v) Frequency of micturition reappears.
vi) Fetal movements are more pronounced.

OBJECTIVE SYMPTOMS

i) Palpation of fetal parts.

ii) Palpation of fetal movements.
iii) Auscultation of fetal heart sound.
iv) Occasional auscultation of funic souffl.
v) Cutaneous changes are more prominent with
increase pigmentation and striae.
vi) Uterine shape is changed from cylindrical to
spherical by 36 th week.
vii) Fundal height: The distance between umbilicus
and ensiform cartilage is divided into three equal
parts.

FUNDAL HEIGHT

Pregnancy in
weeks
At 32th week
At 36th week
At 40th week

Fundal height
Junction of upper and middle third of
ensiform cartilage
Up to the level of ensiform cartilage.
Down to the 32th week due to
engagement of presenting part.

MINOR AILEMENTS
DURING PREGNANCY

OBJECTIVES OF
PRESENTATION

At the end of study students will

Able to define minor ailments.
Able to explain minor ailments
vascular system.
Able to explain minor ailments
Gastrointestinal system.
Able to explain minor ailments
system.
Able to explain minor ailments
Musculoskeletal system.
Able to explain minor ailments
Neurological system.
Able to explain minor ailments
system.

be :
related to Cardiorelated to
related to Respiratory
related to
related to
related to Uro-genital

DEFINITION

The

minor complaints of pregnant women

that occur due to physiological alterations of
hormones ( oestrogen, progesterone,
prolectin) and other causative factors which
can be managed without medical
interventions.

CARDIO-VASCULAR
SYSTEM

Aim of management.
Prediction & prevention.
First aid treatment outside the
hospital.
General management ( Medical &
Nursing )
Specific Management.
Obstetric Management.

SUPINE HYPOTENSION
SYNDROME
Supine hypotensive syndrome is caused when the inferior vena cava is
compressed by the weight of a pregnant females uterus, fetus, placenta and amniotic
fluids while lying in the supine position.
These condition can develop as early as the second trimester but is maximal
during the third trimester (36-38 weeks).
MANAGEMENT :
Place patient in left lateral recumbent position or elevate right hip.
High flow oxygen via non-rebreather.
Treat for shock if other signs of shock are present.
Keep patient warm.
Transport with quite gentle ride to the hospital.

SUPINE HYPO TENSION

SYNDROME

VARICOSE VEINS &

HAEMORRHOIDS
Varicose vein in legs and vulva= Varicosity.
Varicose vein in rectum = Haemorrhoids.
Varicose veins are swollen veins that may bulge near the surface of the
skin due to hormonal changes, increase blood volume & decrease venous
return.
Haemorrhoids swollen and inflamed veins in anus and lower rectum are
another form of varicose veins.

CAUSES:
Increased volume of circulating blood during pregnancy
Pressure of pregnant uterus on larger veins.
Obstruction in venous return by pregnant uterus.
Due to raised progesterone level causing walls of vein to relax.
Due to progestin hormone, which cause veins to be more dilated or open.
Multiple pregnancy.
Tendency to constipation.

CONT...

Management:
Exercise daily.
Elevate feet higher to the level of heart and legs on regular
time interval.
Use a stool or box to rest legs when sitting.
Dont cross legs or ankle when sitting.
Dont sit or stand for long periods without taking.
Sleep on left side- use a pillow to keep body tilled to the
left and elevate feet with pillow since inferior vena cava is
on right side.
Keep constipation away by drinking plenty fluids, add extra
fiber to diet.

VARICOSE VEINS

HAEMORRHOIDS

OEDEMA
Edema occurs when body fluids increase to nurture both mother and
fetus and accumulate in tissues due to increase blood flow. It starts
arruond 22-27 weeks of pregnancy.
CAUSES :
Increase in body fluids as a result of increase blood flow.
Pressure of growing uterus on pelvic veins and vena cava.
MANAGEMENT :
Avoid long period of standing and sitting.
Elevate feet.
Perform appropriate pregnancy exercises. Walking, swimming, etc
Avoid tight elastic socks or stockings.
Wear comfortable shoes.
Limit salt intake.
Massage the swelling area.
Try to sleep on left side.

GASTRO-INTESTINAL
SYSTEM

MORNING

SICKNESS

It appear following the first or second missed period

(around 6th week) and subside by the end of first trimester(
12th week).
It can continue for longer or return at around 32 weeks.
Causesi.
ii.
iii.
iv.

Increase level of HCG hormone.

An enhanced sense of smell and sensitivity to odors.
A sensitive stomach ( mainly empty stomach)
Psychological stress

v.

Multiple pregnancy ( Twin or more )

CONT....
Management
1. Eat small amounts of food often rather than several large meals to avoid
empty stomach.
2. Drink plenty of fluids in between meals to avoid stomach fullness.
3. Quit smoking and ask family members to stop smoking as well as.
4. Keep window open for good ventilation.
5. Get plenty of rest and sleep whenever you can. Avoid lying down after
eating.
6. Try to avoid foods and smells that trigger nausea of someone.
7. Try to eat food cold or at room temperature because food tends to have
stronger smell when hot.
8. Avoid smell of heavy perfume, warm room, certain visual stimuli.
9. If possible eat some dry food like bread, biscuit, low-fat food,
carbohydrate rich food (e.g Rice, noodles, mashed potatoes)
10. Try some sour drink ( e.g. Lamonade, plum juice etc)
11. Avoid eating deep fried, greasy food, garlic and other spices and avoid
drinking coffee.

HEART BURN

Causes :
I.

Relaxation of oesophagal sphincter.

II. Decrease frequency of stomach contraction, making digestion sluggish

and leading to acidity.
III. Enlarged uterus can crowd the abdomen, pushing stomach acid upward.

Management:
1) Eat 5-6 smaller meals throughout the days rather than 3 large meals.
2) Wait an hour after eating to lie down.
3) Avoid spicy, greasy, fatty foods.
4) Eat yogurt or drink a glass of cold milk when acidity causes burning
sensation.
5) Drink less while eating, drink between meals.
6) Place pillow under shoulder to prevent acid

reflex.

7) Sleep with extra pillows so your head is raised.

8) Wear loose fitting clothing.

CONSTIPATION

Causes:

Emotional stress :

Minimal physical exercise :

Relaxation of intestinal muscle due to pregnancy hormone :

Pressure of expanding uterus on intestine :

Sometimes due to iron tablet

Management:
Drink plenty of fluid at least 8-12 glasss every day in form of water,
milk, juice, soup etc.
Increase dietary fiber ( e.g. wheat, fresh fruit and vegetables,
legumes)
Low impact exercises such as swimming, walking or yoga.
Maintain active lifestyle.
Find natural way to get iron.

RESPIRATORY
SYSTEM

BREATHLESSNESS

Causes:
Bodys adaption to carry fetus.
Upward shifting of ribcage due to pregnant uterus.
Progesterone hormone help in adaptation by absorbing oxygen in blood
stream via lungs.
Enlargement of uterus.
Pressure of gravid uterus on lungs.
Stair climbing.

Management:
Sits up straight and keep shoulders back to give space to the lungs to
expands.
Stands up, this will relieve some of pressure on diaphragm.
Stay hydrated and maintain body weight.
Yoga and light exercise with rest in between them.
Use extra pillows while sleeping

NASAL STUFFINESS

Causes:
Estrogen and progesterone.
Allergies and infections.
Season

Management:
Use right blow techniques means use thumb to close one
nostril and blow gently out the other side.
Put warm mist humidifier in room
Use petroleum jelly in each nostril to smoothen.
Vitamin c , reduce chances of nose bleed.

MUSCULOSKELETAL
SYSTEM

BACK

ACHE & LORDOSIS

Causes
1. Hormone change
2. Anterior tilt of pelvis
3. Weight gain
4. Posture change
5. Muscle separation
6. Stress
7. Hyperlordosis

LORDOSIS

LEG CRAMPS
Causes:
Deficiency of diffusible calcium and magnesium ions.
Increase serum phosphorus.
Compression of blood vessels in legs.
Due to fatigue from carrying pregnancy weight.

Management:
Stretch and massage affected muscle to disperse the builds up of acids.
Apply a warm peck to affected muscle.
Walk around.
Leg exercises.
Stay active with regular physical activity.
Stay hydrated.
Choose proper footwear, flat soles.
Take calcium and magnesium supplement. Warm bath before going to bed.

NEUROLOGICAL
SYSTEM

SLEEP DISTURBANCE

Causes:
Urgency of urination.
Physical and emotional stress.
Excess daytime sleepiness.
Pressure of growing fetus.
Heart burn, cramps, congestion in nose.
Caffeinated drinks.
Over exertion.

Management:
Avoid caffine.
Daily work out .
Take warm bath.
Deep breathing exercises.
Meditation & yoga.
Noise free atmosphere.
Wear loose cotton clothes.
Stay stress free

CARPEL TUNNEL
SYNDROME

Causes:
Pressure of extra fluid on median nerve.
Repetitive wrist movements such as typing.

Management:
Try to sleep with hands slightly raised up on pillow.
Avoid repetitive movements and sustained positions.
Carry things with forearms, not with arms.
Massage wrist.
Hold hands on pillow to distribute bodys weight while sleeping.
Light exercisesHold fingers stretched out and then relax.
Make a fist and straighten out fingers.
Move hands slowly up and down, side to side, in round circle.

CARPAL TUNNEL
SUNDROME

UROLOGICAL
SYSTEM

FREQUENCY OF URINATION

Causes:
Increase in blood flow to kidneys by 50%.
Hcg hormone.
Extra weight during pregnancy causes pressure on bladder and pelvic
floor.
Relaxation effects of progesterone on smooth muscle of urinary tract.
Urinary tract infection.

Management:
Never restrict fluid intake because this might increase chance of UTI.
Regular pelvic exercise during pregnancy and after pregnancy will help.
Stay away from caffeinated drinks.
Avoid drinking fluid right before bed time.
Empty bladder completely.
Wear sanitary pads or panty shield.

INTEGUMENTARY
SYSTEM

WARNING SIGNS OF
MINOR AILMENTS DURING
PREGNANCY
Some warning signs that should not be ignored because
theses may results in life threatening complications are as
follows:
Excess nausea vomiting.
High fever.
Foul vaginal discharge or infection.
Pain or burning during urination.
Slowed or stopped fetal movements less than usual.
Spotting or bleeding more than usual along with camps.
Excess swelling.
Shortness of breath.
Severe or persistent abdominal pain & tenderness.
Pelvic pressure( feeling of pushing down of fetus)
Persistent leg cramps.
Trauma to abdomen.