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PREGNANCY
The Whole Period of Pregnancy Can Be Divided
Into Three Stages (Trimesters ):
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Trimesters Weeks

First trimester (early pregnancy) 1-12

Second trimester (middle pregnancy) 13-27

Third trimester (late pregnancy) 28-40

GESTATIONAL AGE
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Nagele’s Rule
 Add 7 days to the first day of the last normal menstrual

period, subtract 3 months and add 1 year.

 Example:
 1st day of LNMP=December 16 2006
 add 7 days = Dec. 23 2006
 subtract 3 months = Sept 23 2006
 add 1 year =Sept 23 2007, estimated due date (EDD)

Johnson’s Rule: estimates the weight of the fetus in grams.

Sign and symptoms of pregnancy
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A. Cessation of menstruation
This is the first frequent symptom of pregnancy,
although a few women may have slight bleeding after
conception. But amenorrhea is not only due to
pregnancy but also other reasons. Women of breast
feeding may be pregnant before the recovery of
menses.
Sign and symptoms of pregnancy
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 B. Nausea and vomiting

Also called morning sickness because they occur

upon arising. These symptoms appear one or two
weeks after the period is missed and last until 10th
to 12th week, its severity varies from mild nausea to
persistent vomiting (e.g. Hyperemesis
gravidarum).
Sign and symptoms of pregnancy
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 C. Urinary symptoms

Increased frequency of urination is due to

increased circulation associated with the effect
of estrogen and progesterone on the bladder,
combined with pressure by the gradually
enlarged uterus on the bladder.
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Sign and symptoms of pregnancy
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d. Breast changes

Breast enlargement and vascular

engorgement. Nipple and areola become
blacker. Enlargement of the accumulated
sebaceous glands of the areolas may be
noted.
e. Fatigue and dizziness
Sign and symptoms of pregnancy
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J . Pregnancy test
The laboratory test for pregnancy are based
on the identification of human chorionic
gonadotrophin (hCG), which can be
detected as early as 7-9 days after
fertilization by high sensitive technique.
The samples may be blood or urine.
Sign and symptoms of pregnancy
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h. Basal body temperature (BBT)

A persistent elevation of BBT for
longer than 18 days may be
presumptive evidence of pregnancy.
 Call the doctor if any of the following occur :
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 Vaginal bleeding
 Sharp abdominal pain or cramping
 Loss of fluid from the vagina
 Severe or prolonged nausea or vomiting
 Frequent dizzy
 Painful urination
 High fever.
 Vaginal discharge that is irritating
 Changes of the reproductive organs
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Vagina: The vaginal wall become

discoloration as the pelvic blood vessel
becomes congested.

 Cervix: Cyanosis and a gradual

softening due to congestion.
 Changes of the reproductive organs
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 Uterus:enlargement and softening. The

isthmus of the uterus is also soft and can be
compressed between the fingers palpating
vagina and abdomen (Hegar’s sign). After the
12th week, the fundus of the uterus is usually
palpable above the symphysis pubis.
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 Ultrasonography
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 Thereare trans-vaginal and abdominal

Ultrasonagraphys.

A gestational sac can usually be identified at

5-6 weeks after the beginning of the last
period.
 Picture of gestational sac
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 Ultrasonography
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 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.
 Picture of normal fetus
a ． Pregnancy of 8w ； b ． Pregnancy of
18w
BL-bladder ； UT-uterus ； GS-gestational
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sac
 Height of the uterine top
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xiphoid
Different methods of pregnancy
diagnosis
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 1 Month
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 First Trimester
At the end of four weeks:
 Baby is 1/4 inch in length
 Heart, digestive system,
backbone and spinal cord begin
to form.
 Placenta begins to develop
 The single fertilized egg is now
10,000 times larger than size at
conception
 Month 2
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 First Trimester
At the end of 8 weeks:
 Baby is 1-1/8 inches long
 Heart is functioning
 Eyes, nose, lips, tongue, ears and
teeth are forming
 Penis begins to appear in boys
 Baby is moving, although the
mother can not yet feel
movement
 Month 3
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 First Trimester
At the end of 12 weeks:
 Baby is 2 1/2 to 3 inches long
 Weight is about 1/2 to 1 ounce
 Nails start to develop and earlobes are
formed
 Arms, hands, fingers, legs, feet and toes
are fully formed
 Eyes are almost fully developed
 Baby has developed most of his/her
organs and tissues
 Baby's heart rate can be heard at 10
weeks with a special instrument called
a Doppler
 Month 4
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 Second Trimester
At the end of 4 months:
 Baby is 6 1/2 to 7 inches long
 Weight is about 6 to 7 ounces
 Baby is developing reflexes, such as sucking
and swallowing and may begin sucking
his/her thumb
 Tooth buds are developing
 Sweat glands are forming on palms and
soles
 Fingers and toes are well defined
 Sex is identifiable
 Skin is bright pink, transparent and covered
with soft, downy hair
 Although recognizably human in
appearance, the baby would not be able to
survive outside the mother's body
 Month 5
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 Second Trimester
At the end of 5 months:
 Baby is 8 to 10 inches long
 Weight is about 1 pound
 Hair begins to grow on baby's head
 Soft woolly hair called lanugo will
cover its body.
 Mother begins to feel fetal
movement
 Internal organs are maturing
 Eyebrows, eyelids and eyelashes
appear
 Month 6
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 Second Trimester
At the end of 6 months:
 Baby is 11 to 14 inches long
 Weight is about 1 3/4 to 2
pounds
 Eyelids begin to part and eyes
open sometimes for short
periods of time
 Skin is covered with protective
coating called vernix
 Month 7
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 Third Trimester
At the end of 7 months:
 Baby is 14 to 16 inches long
 Weight is about 2 1/2 to 3 1/2
pounds
 Fat layers are forming
 Organs are maturing
 Skin is still wrinkled and red
 If born at this time, baby will be
considered a premature baby and
require special care
 Month 8
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 Third Trimester
At the end of 8 months:
 Baby is 16 1/2 to 18 inches long
 Weight is about 4 to 6 pounds
 Overall growth is rapid this month
 Tremendous brain growth occurs at this
time
 Most body organs are now developed
with the exception of the lungs
 Movements or "kicks" are strong enough
to be visible from the outside
 Kidneys are mature
 Skin is less wrinkled
 Fingernails now extend beyond
fingertips
 Month 9
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Third Trimester
At the end of 9 months:
 Baby is 19 to 20 inches long

 Weight is about 7 to 7 1/2

pounds
 The lungs are mature

 Baby is now fully developed and

can survive outside the mother's
body
 Skin is pink and smooth

 Baby settles down lower in the

abdomen in preparation for birth
and may seem less active
 AMNIOTIC FLUID
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 Clear, yellowish fluid surrounding the developing

fetus.
 Average amount 1000 ml.
 < 300ml – Oligohydramnios, associated with fetal
renal abnormalities.
 > 2 L – Hydramnios, associated with GI and other
malformations.
 AMNIOTIC FLUID
31 functions
 Protects Fetus
 Controls Temperature
 Supports Growth
 Prevents Adherence to amnion
 Allows Movement
 Source of oral fluid
 Acts as a excretion
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Health education during pregnancy
 Regular visits during pregnancy
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Prenatal visits
 Q 4 weeks for 1st 28 weeks
 Q 2 weeks until 36 weeks, then
 Q 1 week until childbirth
 Normal Pregnancy Weight Gain
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Breast 1-1.5 lbs

Blood 3-4.5 lbs
Extra water 4-6 lbs
Uterus 2.5-3.0 lbs
Placenta/amniotic fluid 3.5-5.5 lbs
Baby 7-8 lbs
Fat stores 4-6.5 lbs
Total 25-35 lbs
 Risks of Low Weight Gain
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 Low weight gain in second or third trimester

increases risk of intrauterine growth retardation

 Low weight gain in third trimester increases risk of

preterm delivery
 Proper nutrition
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 Major Nutrients
 Carbohydrates
 Protein
 Fat
 Vitamins
 Minerals
 Water
Nursing Process
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 Nursing Diagnosis
 Health-seeking behaviors

 Anxiety

 Risk for deficit fluid

 Constipation

 Disturbed body image

 Risk for altered sexuality patterns

 Disturbed sleep pattern

 Fatigue

 Risk for fetal injury

 Health Promotion During Pregnancy
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 Self-care needs
 Bathing
 Breast care
 Dental care
 Perineal hygiene
 Sexual activity
 Exercise
 Sleep
 Health Promotion During Pregnancy
First-Trimester Discomforts
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 Breast tenderness  Hypotension

 Constipation  Varicosities
 Nausea, vomiting  Hemorrhoids
 Fatigue  Heart palpitations
 Muscle cramps  Frequent urination
 Abdominal discomfort
 Health Promotion During Pregnancy
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 Middle to Late Pregnancy Discomforts

 Backache
 Headache

 Dyspnea

 Ankle edema
 Discomforts associated with pregnancy
1. First trimester
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 Nausea and vomiting (“morning sickness”) related to altered

hormone levels and metabolic changes; advise small snacks of
dry crackers before arising, small feedings of bland food, milk
 Urinary frequency and urgency without dysuria; fluid intake
should not be restricted
 Increased vaginal discharge; manage with good hygiene (but
no douching) and loose-fitting cotton underwear; report signs
or symptoms of vaginitis
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 Breast soreness due to hormonal changes; suggest wearing a

well-fitting, supportive brassiere
 Headache due to tension from emotional and physical stresses
at any time during pregnancy; provide reassurance, suggest
relaxation techniques; inform patient to report persistent
and/or severe episodes
 Second and third trimester
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 Heartburn may be related to tension and vomiting in

early pregnancy, progesterone-induced decreased
motility and relaxation of the cardiac sphincter;
displacement of the stomach by the growing uterus;
encourage small, frequent meals and discourage
overeating, ingesting fried/fatty foods, lying down soon
after eating, use of sodium bicarbonate (would interfere
with sodium balance)
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 Constipation related to progesterone-induced hypoperistalsis,

compression/displacement of the bowel by the enlarging uterus, poor
food choices, lack of fluids, and/or iron supplementation; advise bulk
foods, fruits and vegetables, exercise, and generous fluid intake; avoid
laxatives

 Hemorrhoids due to pelvic congestion related to pressure from enlarged

uterus; suggest regulation of bowel habits, gentle reinsertion into rectum
with use of lubricant, relief measures, e.g., ice packs, topical ointments,
sitz baths, lying down with legs elevated
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 Uterine contractions (Braxton-Hicks) due to tension on the round

ligaments as a result of displacement of the uterus; instruct patient
to rest, change position or activity

 Backache due to increased spinal curvature; educate the patient

on the importance good posture

 Faintness related to vasomotor lability or postural hypotension;

instruct the patient to use slow, deliberate movements when
rising, avoid prolonged standing and warm, stuffy environments;
elastic hose may be needed
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 Leg cramps related to pressure on the nerves supplying the lower

extremities aggravated by poor peripheral circulation or fatigue;
instruct the patient to increase calcium and decrease phosphorus
intake; encourage dorsiflexion of feet

 Ankle edema related to decreased venous return from lower

extremities, instruct the patient to avoid wearing anything that
constricts blood flow, elevate legs when sitting or resting, and
dorsiflex feet when sitting or standing for any length of time;
medical management if edema persists in AM, is pitting, involves
the face, or associated with elevated BP, proteinuria, persistent
headaches
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 Varicosities of extremities or vulva related to uterine

compression of venous return, increased vein wall
distensibility from progesterone-initiated relaxation, or
inherited tendency; suggest elevating legs frequently, avoid
sitting with legs crossed, standing/sitting for long periods of
time, or wearing constrictive clothing; support/elastic
stockings may be helpful.
 Danger Signs of Pregnancy
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 Abdominal or chest pain  Vaginal bleeding

 Pregnancy-induced  Persistent vomiting
hypertension  Chills and fever
 Increase or decrease in  Ruptured membranes
fetal movement
 Teratogens
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Any factor that adversely affects fertilized

ovum, embryo or fetus
 Teratogenic Fetal Exposure
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 Maternal infections: Toxoplasmosis, Rubella,

Cytomegalovirus
Herpes simplex virus, Syphilis
 Vaccines

 Drugs

 Alcohol

 Cigarettes
 Teratogenic Fetal Exposure
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 Environmental
 chemical
 Radiation
 Hyperthermia and hypothermia
 Maternal stress
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