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Pregnancy. By Sr. Siti Norhaiza Hadzir. Pregnancy. If ovum is fertilized it may implant in endometrium The function of LH is taking over by human chorionic gonadotrophin (HCG) HCG is produced by placenta HCG prevent the involution of corpus luteum
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Pregnancy By Sr. Siti Norhaiza Hadzir
Pregnancy • If ovum is fertilized it may implant in endometrium • The function of LH is taking over by human chorionic gonadotrophin (HCG) • HCG is produced by placenta • HCG prevent the involution of corpus luteum • Estrogen and progesteron raises and endometrium sloughing is prevented
Prolactin secretion increased after eight weeks of pregnancy • Prolactin, estrogen and progesteron stimulates breast development • High plasma estrogen inhibit milk production
Fertilization • Occur at the end of Fallopian tube • Sperm motility is important • Sperm half life 2-3 days ovum 24 hours • Pregnancy is counted from the first day of last menses. • Baby is almost 2 weeks younger than pregnancy period.
The duration is 9 months 10 days/280 days/40 weeks • Zygote (ovum + sperm) is brought to the uterus (within 4 days fertilization) • Endometrial stabilization —amenorrhea. • Human chorionic gonadotrophin (HCG) can be detected after 10 days fertilization. • Positive pregnancy test.
Maternal Changes • Weight gain (10-12 kg) • Changes in the pelvic • Cardiovascular changes increase in stroke volume/ cardiac output/heart rate/blood volume • Changes in pulmonary function- to supply oxygen to the fetus. • Cause dyspnea
The effect of pressure to the abdomen Veracious vein Renal hypertension gastritis (slowing in motility) Leg edema • Increase in the rate of metabolism • Decrease GIT motility– constipation, nausea, vomiting • Skin-chloasma, linea alba, striae,
Fat deposition especially triglyceride • Hypervolemia • Increase in erytropoiesis
Aim • To detect fetus abnormality • To monitor the progress of pregnancy
Monitoring pregnancy • HCG reaches peak at 13 weeks of pregnancy • Crude test of plasma and urine HCG give positive result after one or two weeks of missed period. • Immunoassay detected soon after implantation of ovum for pts treated for infertility
Human placenta lactogen (HPL) produced at eight weeks of pregnancy. To assess abortion or late pregnancy • Now assessment of fetal well being is replace mainly by Ultrasound
Amniocentesis • To obtained amniotic fluid • Needle is inserted into uterus through maternal abdomen • Done after 14 weeks of pregnancy • Done together with U/sound guide • Perform only for strong clinical indication and if diagnosis cannot be made by un-invasive procedure
Avoid • Specimen contaminated with maternal, or fetal blood and urine • Not fresh
Amniocentesis • Detection of neural tube defect • AFP to detect neural tube defect such as spinal bifida, anencephaly • Alpha fetoprotein is produced by liver and yolk sac • AFP can also caused by multiple pregnancy • Down Syndrome • Low AFP and raised HCG measured between 16-18 weeks
Assessment of fetomaternal blood group incompatibility • Measure fetus bilirubin
Maternal Biochemical changes • Increased in carrier protein • Increase in Total T4 and Cortisol (TBG and CBG high, Free T4 and cortisol normal), • Increased transferrin or TIBC • Increased ALP (placenta isoenzyme) • Low Protein and albumin (dilution) • Glucosuria (increased GFR) • Low calcium (bcause bind to albumin)
PIH • also be called preeclampsia • pregnancy complication • Characterized by high blood pressure,oedema and proteinuria. • One out of every 14 pregnant women • Can also occur in subsequent pregnancies • More common in pregnant teens and in women over age 35 • develops usually after the 20th week, but it can also develop at the time of delivery or right after delivery.
Symptoms • Rapid or sudden weight gain • High blood pressure. • Protein in the urine. • Swelling* in the hands, feet and face • Severe headaches • Change in reflexes • Reduced output of urine or no urine • Blood in the urine • Excessive vomiting and nausea.
Who is at risk of • Is under age 20 or over age 35 • Has a history of chronic hypertension • Has a previous history of PIH • Has a female relative with a history of PIH • Is underweight or overweight • Has diabetes before becoming pregnant • Has an immune system disorder, such as lupus or rheumatoid arthritis • Has kidney disease • Has a history of alcohol, drug or tobacco use • Is expecting twins or triplets
What is the danger of PIH? • PIH can prevent the placenta from receiving enough blood, which can cause low birth weight in the baby. • Placental abruption, a complication that occurs when the placenta pulls away from the wall of the uterus • Severe bleeding • Seizures • Early delivery of premature baby • Stillbirth
How is PIH treated? Mild PIH • Can be treated at home. • Need to maintain a quiet, restful environment with limited activity or bed rest. • Follow the diet and fluid intake guidelines. • Maintain scheduled Clinic appointments. • Constant perception of fetal movement is also important.
Severe PIH • Hospitalization for closely monitoring. • Health care provider will work with pt to maintain the health of mother and the baby. • In severe cases, the baby may have to be delivered. • Both severe and mild PIH pt is given antihypertensive drugs.
Definition • Gestational diabetes is a type of diabetes that occurs only during pregnancy. • Like other forms of diabetes, gestational diabetes affects the way the body uses blood glucose • Blood sugar level is too high.
Causes • During pregnancy, the placenta produces hormones that prevent insulin action. • These hormones, which include estrogen, cortisol and human placental lactogen, are vital to preserving pregnancy. • Yet they also make the cells more resistant to insulin. • As the placenta grows larger in the second and third trimesters, it secretes even more of these hormones, further increasing insulin resistance. • Normally, the pancreas responds by producing enough extra insulin to overcome this resistance.
During pregnancy, the body need up to 3x as much insulin as normal, and sometimes the pancreas simply can't keep up. • When this happens, intracellular glucose is decrease, and too much stays in the blood. • It usually occurs about the 20th to 24th week of pregnancy and can be measured by the 24th to 28th week of pregnancy. • Blood sugar levels should quickly return to normal after delivery.
Risk factors • Age more than 25 yrs old • Family or personal history of diabetes • Overweight before pregnancy • Previous complicated pregnancy. Unexplained stillbirth or a baby who weighed more than 9 pounds.
Screening and diagnosis • A urine sample isn't a reliable indicator of gestational diabetes because the amount of sugar in urine can vary throughout the day and as a result of dietary • In some places, screening for gestational diabetes is a routine part of prenatal care for all women. • To screen for gestational diabetes, most doctors recommend a glucose challenge test (OGTT). • This test is usually done between 24 and 28 weeks of pregnancy, because the condition usually can't be detected until then. • However, if pts are at risk, the test may be performed earlier.
Complications(baby) • Macrosomia –big baby, a birth weight of 4.5kg (9 pounds, 14 ounces) • Shoulder dystocia.Baby is too big to move through the birth canal. • Hypoglycemia.Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth • Stillbirth or death
Complications to mothers • Preeclampsia. • Operative delivery • Gestational diabetes in another pregnancy • Type 2 diabetes as they get older
Treatment • Controlling blood sugar is essential to keeping the baby healthy and avoiding complications during delivery. • Most women with gestational diabetes are able to control their blood sugar with diet and exercise. • Some may need anti-diabetic drug. • Monitoring blood sugar will tells whether blood sugar is staying within a normal range.
Patients Monitoring • Monitoring own blood sugar. • Eating healthy diet • Diet consultation • Regular exercises • Taking medications (glyburide, metformin may be safe and effective) • Baby monitoring (prevent the pregnancy from going longer than 40 weeks-complication)
Hyperemesis gravidarum is a severe and intractable form of nausea and vomiting in pregnancy. • The peak incidence is at 8-12 weeks of pregnancy, and symptoms usually resolve by week 16. • It is a diagnosis of exclusion and may result in weight loss; nutritional deficiencies; and abnormalities in fluids, electrolyte levels, and acid-base balance, acidosis.
The prevalence increases in molar pregnancies (hidatidiform mole) and multiple pregnancies. • The incidence is higher in younger women than in older women
The most common cause of anemia in pregnancy is iron deficiency. • The baby will really start to draw on iron reserves around week 20. • Type hypocromic normocytic
Clinical features • being tired • feeling weak • pale skin • palpitations • breathlessness • fainting spells
15mg of iron per day pre-conception • Many women who aren't pregnant do not even reach the RDA each day. • Pregnant women need almost twice the amount of iron per day.
Taking iron supplements can often cause constipation, nausea and vomiting, • Iron-Rich Foods liver spinach dried fruits • Maximize Your Iron AbsorptionTaking vitamin C-rich foods along with the iron will increase absorption of the iron. However, taking caffeinated beverages along with high-iron foods will reduce the amount of iron that your body absorbs.
