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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

Pregnancy

By

Sr. Siti Norhaiza Hadzir


Pregnancy1
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



Fertilization
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
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,




Aim

  • To detect fetus abnormality

  • To monitor the progress of pregnancy


Monitoring pregnancy1
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



Amniocentesis
Amniocentesis pregnancy. To assess abortion or late pregnancy

  • 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 pregnancy. To assess abortion or late pregnancy

    • Specimen contaminated with maternal, or fetal blood and urine

    • Not fresh


Amniocentesis1
Amniocentesis pregnancy. To assess abortion or late pregnancy

  • 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



Maternal biochemical changes
Maternal Biochemical changes pregnancy. To assess abortion or late pregnancy

  • 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)


Pregnancy and disease

Pregnancy and disease pregnancy. To assess abortion or late pregnancy


Pregnancy induced hypertension

Pregnancy induced hypertension pregnancy. To assess abortion or late pregnancy


PIH pregnancy. To assess abortion or late pregnancy

  • 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
Symptoms pregnancy. To assess abortion or late pregnancy

  • 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
Who is at risk of pregnancy. To assess abortion or late pregnancy

  • 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
What is the danger of PIH? pregnancy. To assess abortion or late pregnancy

  • 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
How is PIH treated? pregnancy. To assess abortion or late pregnancy

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 pregnancy. To assess abortion or late pregnancy

  • 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.


Gestational diabetes

GESTATIONAL DIABETES pregnancy. To assess abortion or late pregnancy


Definition
Definition pregnancy. To assess abortion or late pregnancy

  • 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
Causes pregnancy. To assess abortion or late pregnancy

  • 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
Risk factors normal, and sometimes the pancreas simply can't keep up.

  • 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
Screening and diagnosis normal, and sometimes the pancreas simply can't keep up.

  • 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
Complications normal, and sometimes the pancreas simply can't keep up. (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
Complications to mothers normal, and sometimes the pancreas simply can't keep up.

  • Preeclampsia.

  • Operative delivery

  • Gestational diabetes in another pregnancy

  • Type 2 diabetes as they get older


Treatment
Treatment normal, and sometimes the pancreas simply can't keep up.

  • 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
Patients Monitoring normal, and sometimes the pancreas simply can't keep up.

  • 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

HYPEREMESIS GRAVIDARUM normal, and sometimes the pancreas simply can't keep up.


  • 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.



Anemia in pregnancy

ANEMIA IN PREGNANCY nausea and vomiting in pregnancy.



Clinical features
Clinical features deficiency.

  • being tired

  • feeling weak

  • pale skin

  • palpitations

  • breathlessness

  • fainting spells


  • 15mg of iron per day pre-conception deficiency.

  • 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.


Thank you

Thank you and vomiting,


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