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cryptic pregnency by Noaman Ali

Some Pregnency with in 5 years Unknown Pregnency

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cryptic pregnency by Noaman Ali

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  1. OBJECTIVES PREGNACY By the end of this presentations learner will be able to: • Define PREGNACY • Discuss how pregnancy happened • Discuss the Physiological changes of pregnancy • Duration of the NormalPregnancy • Explain the Developmental stages of the Fetus and duration • Describe the sign and symptoms of Pregnancy

  2. Define CRYPTIC • Case Study Cryptic pregnancy • Define Cryptic pregnancy • Explain the Causes of Cryptic pregnancy • Discuss Common Symptoms of Cryptic Pregnancy OBJECTIVES

  3. Epidemiology of Cryptic pregnancy • Explain the Cryptic Pregnancy Undetected in an Ultrasound • Why Do Urine and Blood Tests Show Negative Results? • Periods During Cryptic Pregnancy • Prevent a Cryptic Pregnancy • Discuss the Treatment OBJECTIVES

  4. Pregnancy Pregnancy Cryptic Pregnancy

  5. Pregnancy It is the period from fertilization tobirth.

  6. Physiology • It starts when a male’s sperm fertilizes a female’s egg (ovum) in the woman's fallopian tube, making a (Zygote) with 46 chromosomes. • The zygote starts to divide, and after five to seven days of dividing and growing, it attaches itself to the wall of the uterus.

  7. Continue • The moment it is implanted in the wall of the uterus it becomes an (Embryo) and the placenta starts todevelop. • After 8 weeks, the developing embryo called(Fetus). • The placenta give the embryo/fetus the oxygen and nutrition, and removes the waste through the umbilicalcord.

  8. Physiological Changes • Pregnancy causes physiological changes in all maternal organ systems; most return to normal after delivery. • Increased blood supply to breasts anduterus. • Increased levels of estrogen andprogesterone. • Changes in senses of taste and smell, and increase insaliva. • Softening of joints, and increased mobility of the sacroiliac and symphysispubis. • Increased in bloodflow.

  9. PhysiologicalChanges • Increased need for glucose, H2O, iron, and folic acid due to developingfetus. • Heart rate increases from the normal 70 to as high as 90beats/min. • Decrease in blood pressure in first and second trimesters and became normal at the third trimester. • Increased breathingrate. • Increase in kidney and bladdersize. • High pigmentation of theskin.

  10. How pregnancy happen?

  11. Duration of the NormalPregnancy 280days • or > 9months • or > 40weeks • or > 3trimesters • Normal delivery couldbe from 38 – 42weeks.

  12. Developmental of Fetus in Uterus • Developmental of Fetus in Uterus According into threeTrimesters and it’s sign & symptoms… • 1- First Trimester (1 week -12 week) • During the first trimester hormonal changes affect almost every organsysteminbody. • The baby develop rapidly. The major organs develop in thistrimester. • The menstruationstopped. • Pregnant symptoms and signs (Mood swings, headache, morningsickness).

  13. Conti………… • The baby’s brain, heart and spinal cord have begun toform. • Baby's heart starts to beat in the 8thweek. • The sex organs begin toform. • The face starts toform. • At the end of eight weeks, the baby is a fetus and looks more like a human, and about 2.5cm. • At 12 weeks we can see if he is a boy or girl. And the baby can make afist.

  14. Conti……….. • 2- Second trimester (13 week - 28 week) • Most of the early pregnancy symptoms will graduallydisappear. • Other symptoms appears such as: backache, leg swollen, andheartburn. • Stretch marks on the abdomen andbreasts. • The uterus will grow rapidly insize • Fetus move at about 18 to 22weeks. • Increaseofheartrateandbloodflowtoaccommodatetheneedsofthe fetus.

  15. Conti……… • Muscle tissue and bone continue toform. • Skin begins to form in the 16thweek. • The baby can hear and swallow at the 20thweek. • Realhairbeginstogrowonyourbaby'sheadat24thweek.Thelungsareformed,butdonot work. • At the end of the trimester, the baby now about 30cm.

  16. Conti…….. • 3- Third trimester (29 week - 40 week) • During this final trimester, your fetus grows larger and the body organs mature. The fetus moves frequently, especially between the 27th and 32nd weeks. • A fetus usually set into a head-down position in theuterus. • Shortness of the motherbreath. • Belly button of the mother may stickout. • The breasts begin to produce colostrum (yellowish richmilk).

  17. Conti…… • The baby’s bones are fully formed at 34thweek. • The eyes can open and close and sense changes inlight. • By the end of 37 weeks, the baby is considered full term and the organs are ready to function on theirown. • Near the due date, the baby may turn into a head-down position forbirth.

  18. Signs OfPregnancy 1- PresumptiveSigns: • (physiological changes noticed by the womanherself) • Absence of menstruation(Amenorrhea) • Nausea and vomiting (morning sickness): common from week 2–12. • Breast tenderness, andswollen. • Urinationfrequency. • Fatigue andsleepiness.

  19. Signs ofpregnancy 2- ProbableSigns: • (physiological and anatomical changes that can be perceived by the health careprovider) • Chadwick’s sign:darkness of thevulva. • Goodell’s sign: Softening of the cervix and vagina with increased in discharge. • Hegar’ssign:Softening of the lower uterinesegment.

  20. Signs ofpregnancy • Growth of uterus andabdomen. • Skin hyperpigmentation: brownish pigmentation in the face, darkness of nipples, lineanigra(pigmentation of the midline of abdominalskin). • Positive pregnancy test results: detection of human chorionic gonadotropin(hCG)inmaternalurineorblood.Thetestsare accurate, but not100%.

  21. Signs ofpregnancy 3- PositiveSigns: • (Objective signs of pregnancy noted by the examiner by positive examination of theembryo) • Sonographic visualization of the embryo: Cardiac movement noted at 4–8weeks. • Fetal heart beat: by using a Doppler in the10–12weeks. • Fetal movement: felt by the examiner after about 20weeks.

  22. Supplement Given During Pregnancy • 400 micrograms of folic acid every day – from before you're pregnant until you're 12 weeks pregnant in order to prevent birth defects known as neural tube defects, including Spina bifida. • Iron supplements is given to prevent from anemia .e.g Iberet-Folic-500mg OD, fefol VIT(iron, vitamins &folic acid) • Calcium and vitamin D in pregnancy is important because Calcium and VIT D is vital for making your baby's bones and teeth. E.gCaC 1000, tab Osnate D • 2 Tetanus Toxoid dose is given in pregnancy in order to prevent from tetanus. 1st dose 0.5ml intramuscular given at 7 month and 2nd dose given at 8 month.

  23. CRYPTIC is from Late Latin crypticus, from Greek kryptos, means “Hidden’’.

  24. Case Study Cryptic pregnancy • 24 years old female Patient lived in Canada pregnant from since 2 year with all sign and symptoms she can feel them but no any evidence of medical side and Past medical history • When she went for checkup , Dr said" it’s a cryptic pregnancy we can’t see only you can feel them in 9thmonth, DrAdviced for walk daily.

  25. Cryptic pregnancy Cryptic pregnancy or denial of pregnancy is defined as lack of subjective awareness of pregnancy until final weeks of gestation or delivery. Their relatives, family doctors and sexual partners are also not aware of their gravid state. (Nto Johnson Ntodoi: 10.11604/pamj.2020.36.205.23790)

  26. Causes Polycystic Ovarian Syndrome (PCOS) • This condition can limit your fertility, create hormonal imbalances, and cause skipped or irregular periods.

  27. Perimenopause Time between when your period begins to grow less consistent and when it stops completely, which is marked by menopause and decline in estrogen hormones.

  28. Low Body Fat For athletes or women with low body fat, hormonal levels may fluctuate, resulting in missed periods. This also makes it harder to detect a pregnancy.

  29. Stress Nowadays, we face a lot of stress due to work or family problems. Stress is one of the major factors of fluctuating hormone levels, especially in women.

  30. Common Symptoms of Cryptic Pregnancy Cryptic pregnancy also shows symptoms, but women often fail to notice them. Period-like bleeding that resembles a regular menstrual cycle Nausea and vomiting that is mistaken for other conditions Fetal movement in the uterus mistaken for gas or indigestion Negative results of urine and blood tests due to fluctuating hormone levels, especially when done very early No sign of pregnancy in early ultrasounds

  31. Epidemiology • According to the Bushaala, Naji Mustafa (2018-05-05) In several cases, the pregnancy goes unnoticed until the would-be mother is twentieth ( 20th) weeks. • According to the Marco Del GiudiceRecent epidemiological studies show that this condition has a much higher incidence than previously thought (about 1:475). • According to the  Dordević, Momcilo; Jovanović, Bozidar; Dordević, Gordana (2010). 1 in 7,225 pregnancies are unknown at the time the mother gives birth.

  32. Cryptic Pregnancy Undetected in an Ultrasound Many times, cryptic pregnancy goes undetected even in an ultrasound. Some reasons for this are:

  33. Retroversion of the Uterus Retroversion of the uterus is a condition where in the uterus tilts either sideward or backwards. If the uterus is in this position, it’s hard for an ultrasound to detect a fetus during early pregnancy.

  34. Bicornuate Uterus Bicornuateuterus is a congenital condition where in the uterus grows in a heart shape with two horn-like tissues that are divided partially or fully by a wall of tissue. This makes it harder for a woman to conceive as well as increases the chances of cryptic pregnancy.

  35. Scar Tissue Scar tissue doesn’t allow the ultrasound to get a clear picture as it blocks the waves of the test. Abnormal scarring may happen due to stomach surgery or incomplete abortion in the past.

  36. Why Do Urine and Blood Tests Show Negative Results? In a normal pregnancy, the result is determined on the basis of the amount of hCG in the blood. hCG is a hormone produced by the placenta during pregnancy. However, in the case of cryptic pregnancy, the uterine lining is regularly removed from the body, not allowing hCG levels to build up. Hence, urine and blood tests cannot detect a pregnancy.

  37. Periods During Cryptic Pregnancy In cryptic pregnancy, women get their period every month. However, the duration of bleeding is short. It occurs at irregular intervals or is random. The flow also ranges from spottingto heavy flow and can be pink, red, black, brownor even purple. This occurs because the uterus is removing the inner lining and is not indicative of a miscarriage.

  38. Prevent a Cryptic Pregnancy • If you’re married and sexually active, look out for the symptoms of a cryptic pregnancy. • If you experience pain or changes in your abdomen or pelvic region, then consult a doctor. • If you don’t get your period regularly, inform your gynecologist about this condition and get yourself checked. • Cryptic pregnancy exercise must. • Being aware and keeping your gynecologist in the loop about your reproductive health is the key to prevent a cryptic pregnancy.

  39. Treatment • Most women do not need to take medication to relieve perimenopausaleffects. • For some women, symptoms are especially bothersome and hormone replacement therapy (HRT)can be helpful. • In other instances, symptomatic treatment aimed at controlling specific effects, such as depression, anxiety, or hair loss, are the best fit.

  40. References • Nto-Ezimah UA, Nto NJ, Esom EA, Okwor CJ, Adiri C. Unexpected delivery: a case report of cryptic pregnancy in Nigeria. The Pan African Medical Journal. 2020;36. • The North American Menopause Society. The Experts Do Agree About Hormone Therapy. • KaunitzAM, Manson JE. Management of Menopausal Symptoms. Obstet Gynecol. 2015;126(4):859–876. doi:10.1097/AOG.0000000000001058

  41. References • Dordević, Momcilo; Jovanović, Bozidar; Dordević, Gordana (2010). "Unknown pregnancy--presentation of the case". Medicinskipregled. 63 (9–10): 728–730. doi:10.2298/mpns1010728d

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