M3

• Presumptive Signs of Pregnancy

  Category in diagnosis of pregnancy
• Probable Signs of Pregnancy


  Category in diagnosis of pregnancy
• General Inspection


  Observe Overall Health
• Expected Date of Confinement

  Computation of LMP, EDC and AOG
• Age of Gestation


  Computation of LMP, EDC and AOG
• Second Maneuver


  Umbilical Grip
• Presumptive Signs of Pregnancy

  Category in diagnosis of pregnancy
• Probable Signs of Pregnancy


  Category in diagnosis of pregnancy
• General Inspection


  Observe Overall Health
• Expected Date of Confinement

  Computation of LMP, EDC and AOG
• Age of Gestation


  Computation of LMP, EDC and AOG
• Second Maneuver

  Umbilical Grip
• Presumptive Signs of Pregnancy

  • Signs which when taken as single entities, could easily indicate other conditions
  • These findings, discussed in connection with the body system in which they occur, are experienced by the woman but cannot be documented by an examiner
• Probable Signs of Pregnancy

  • Are objective signs which can be verified by an examiner
  • Although they are more reliable than presumptive symptoms, they still do not positively diagnose a pregnancy
• Signs of Pregnancy


  Truly reliable signs of pregnancy
• Amenorrhea


  • Absence of monthly menstrual flow
  • Cause: Suppresses Follicle Stimulating Hormones (FSH) —> Ovum Maturation
  • The placenta, which develops in response to the implantation of an embryo, produces a certain hormone called Chorionic Gonadotropin
  • As a result, no new eggs are released and no menstruation occurs since the uterine lining does not deteriorate
• Breast Change


  • Tenderness, fullness, enlargement, darkening of areola and nipples
  • Cause: Estrogen stimulates growth of the breast duct cells and generates the secretion of Prolactin. Prolactin stimulates breast enlargement and milk production
• Nausea and Vomiting


  • Often called "Morning Sickness" but it can occur any time of day or night, usually starts around 5 weeks of pregnancy and is at its worst at about 9 weeks
  • Cause: increase of Human Chorionic Gonadotropin (HCG) and Progesterone
• Frequent Urination


  • Urinates between small intervals with less amount than usual
  • Cause: Growing fetus and abdomen pressing down the bladder
• Fatigue


  • Constant exhaustion, burnout or lack of energy; "always feeling tired"
  • Cause: Increase metabolic requirement can increase the amount of morning sickness
• Uterine Enlargement


  • Growing baby will cause the uterus to increase
  • Cause: Increase the size of the fetus
• Quickening


  • Fetal movement felt by the mother at 16-20 weeks AOG
  • Cause: Movement of the fetus inside the uterus
• Melasma


  • Dark pigmentation found in other parts of the body such as the neck, armpit, nape
  • Cause: An increase in the hormones estrogen and progesterone
  • Also known as Chloasma Mask of pregnancy, if pigmentation is found on the face
• Striae Gravidarum


  • Streaks on the abdomen; stretch marks
  • Cause: Separation of underlying connective tissue as the uterus enlarges within the abdominal cavity
• Positive Pregnancy Test for HCG Detection


  Cause: Increase HCG = hormone created by the Chorionic Villi of the placenta
• Chadwick's Sign


  • Pink to purple/bluish discoloration of the cervix, vagina and vulva; vaginal discoloration
  • Cause: An increase blood flow to the pelvic area caused by high estrogen levels
• Hegar's Sign


  • Softening of the lower uterine segment
  • Cause: A result of the various changes to the consistency of the Cervical Isthmus
• Sonographic Evidence of Gestation

  An imaging method that uses sound waves to produce images of the fetus
• Ballottement


  • When lower uterine segment tapped on bi-manual exam fetus felt to rise on the abdominal wall
  • Cause: Fetus moves upward and then move back downwards upon tapping
• Fetal Outline Felt by the Examiner

  28 weeks palpation of fetal outline
• Evidence of Fetal Outline

  Image of the fetus produced by a sonogram
• Fetal Heart Audible


  • Fetal Heart Rate: 120 – 160 beats/min
  • For 10 - 12 weeks, use a Doppler
  • For 18 - 20 weeks, use a Stethoscope
• Fetal Movement Felt by the Examiner

  • In 16 - 20 weeks, felt by the mother
  • In 20 - 24 weeks, felt by the examiner
• Past Pregnancies: Outcome of each? Number of living children? Complications? Length of labor? Years since last pregnancy?
• Current Pregnancy: Confirmed by Ultrasound? Date of first Prenatal visit? Estimated due date? Prenatal education? Concurrent disease? Medications?
• Anthropometric Measurement


  Height, weight, head circumference, body mass index (BMI), body circumferences to assess for adiposity (waist, hip, and limbs), and skinfold thickness
• General Inspection


  Observe Overall Health, Emotional State, Nutritional Status, Neuromuscular Coordination as the woman walks into the room and climbs on the examination table
• Vital Signs


  • Blood Pressure - increase BP suggests Pregnancy Induced Hypertension (PIH). Range of 90-130/60-89mmHg falls during second trimester, Pre-pregnant level first and third trimesters
  • Cardiac Rate
  • Respiratory Rate - sudden drop of CR and RR suggest bleeding
  • Temperature - elevation suggests infection
• Weight and Height


  • Calculate the BMI with standard tables, using 19 to 25 as normal for the pregnant state
  • First Trimester - weight gain is 2-4 lbs
  • Second Trimester - weight gain is 0.4kg/1lb per week
  • Third Trimester - weight gain is 0.4kg/1lb per week
  • Recommended weight gain throughout the entire pregnancy is 11.2 kgs to 16 kgs
  • Sudden increase in weight of about 25 - 40 kgs suggests fluid retention or Polyhydramnios. Decrease in weight suggest illness and should be carefully evaluated during the prenatal visit
• Head and Neck


  • Face. Mask of pregnancy Chloasma is common, though not present in all pregnancies
  • It consists of irregular brownish patches around the forehead and cheeks, across the nose, or along the jaw