normal pregnancy

OBSTETRICS
Lecture: 1.
Fourth Year Medical College.
Lecturer: Professor Layla Abdul Amir.

Normal Pregnancy
Pregnancy is a physiological process but sometime this physiological process is complicated by pathological cases. So require specific treatment, but in case of normal pregnancy it only require supportive treatment.
Duration of pregnancy:
It is 266 days from the minute of conception and it is 280 days from the day of the last menstrual period in a women of a 28 day menstrual cycle.
We can divide the pregnancy into three periods, each of 14 week and each is called trimester, so the first 14 week called the first trimester, the second 14 week called second or middle trimester and the third 14 week called third trimester.
In first trimester
Symptoms of pregnancy:
1. The first thing noticed is amenorrhoea which means sudden cessation of the period. This type of the amenorrhoea is called physiological type which occurs also during lactation or following discontinuation of oral contraception.
Sometimes bleeding may occur during early pregnancy such bleeding may come from the cavity of the uterus before the decidua capsularis fuses with the decidua vera, but not be regarded as menstrual bleeding.
2. Morning sickness: nausea and vomiting begins at the 5th week and stops spontaneously before 14th wk.
3. Breast symptoms: in early weeks of pregnancy some tenderness and fullness noticed, also nipple and areola increase in size and becomes darker, also Montgomery’s tubercles become prominent and erected.
4. Frequency of micturation: because the enlarging uterus presses on the bladder.
5. Abdominal enlargement: many women notice some abdominal fullness in early pregnancy.
Signs of pregnancy:
1. Enlargement of uterus: uterus enlarged and becomes softer between 6-10th week and during this period the embryo occupying he upper part of the uterus while the lower part is empty, so by bimanual examination the lower soft area can be easily compressed between the fingers on the contrary of the firmer cervix below about ninth week of pregnancy (Hegar’s sign).
2. Cervix become softer although in some cases it remains firm throughout pregnancy.
3. Dusky bluish discoloration of the vulva and vagina.
4. Progressive enlargement of the uterus: by the 12th week, the fundus of the uterus is palpable in abdomen just above the symphysis pubis and progressive enlargement of the uterus follows.
5. Basal body temperature (37.1-37.5?C) is highly suggestive of pregnancy because of the action of progesterone (hyperthermic).
6. Painless contraction: this is called Braxton Hicks contractions and these are painless and are not strong and regular as those of labour.
In second trimester
Symptoms:
1. Amenorrhoea continue throughout pregnancy.
2. Morning sickness: nausea and vomiting will ceases around the 14th week of pregnancy.
3. Quickening: primigravida usually feels fetal movement in about 18-20 weeks of pregnancy, but multiparae recognize the movements two weeks earlier.
Signs:
1. Uterus become palpable.
2. Ballottement: which may be observed from 16-30 week.
- External ballottement by abdominal examination (head can be felt between two hands).
- Internal ballottement by pelvic examination (so the embryo more up and down as we are playing by ball).
3. Palpation of fetal parts which is positive after 24th week of pregnancy.
4. Fetal movement can be felt by palpation.
5. Fetal heart sounds: usually heard after 24th week in rate is 120-150/ minute, this is done by traditional fetal stethoscope or Penard fetal stethoscope.
Fetal heart sound con be detected around 10 week of pregnancy by ultrasonic detector (sonic aid).
6. Uterine contractions become stronger and increase in frequency.