What is Pregnancy

Pregnancy is defined  as fertilization of  sperm with a ova  in women uterus results  in development  one  or more  offspring  when fertilized eggs  covers  a period of   eight weeks ,it is term as embryo  and  above eight  weeks  it is term as  foetus. Normal child birth occurs about 38 weeks after conception. Human pregnancy is divided into three trimesters. In first trimester risks of miscarriage are more. In the second trimester fetal development can easily monitored and diagnosed. The third trimester the fetus has the ability to survive with or without medical help outside the uterus.

Process of Pregnancy

Pregnancy begins with implantation of fertilized egg in the uterus. The fertilized egg completely differentiate into cell, forms the embryo. The outline  of  the  body organs and  the nervous  system developed in eight week of  embryonic  stage ,placenta  and  umbilical cord develop from embryonic  stage to support the  organs. Sex organ appear during the third month of pregnancy. The  fetus grow  in both weight  and  length ,maximum growth of  fetus  takes  place  in the last week of  pregnancy. Pregnancy is considered at term, when gestation has completed 37 weeks.

 Early Pregnancy Signs 

Pregnancy may be detected either by women on basis’s of symptoms by herself, or using medical test.

1. Morning Sickness. Morning Sickness which is interrupted with normal menstrual cycle is the visible sign. Morning sickness, which can strike at any time of the day or night, sometimes begins as early as three weeks after conception.
2. Missed Period. Missed Period Can be the first sign of pregnancy.
3. Increased urination. You might find yourself urinating more often than usual.
4. Physical Signs experienced by women during pregnancy, which are nausea and vomiting,
5. Tiredness. Pregnant women feel excessive tiredness and fatigue during pregnancy  
6. Food Craving.  Food cravings are common is common in pregnant women.
7.  Medical Signs: First week of pregnancy presumptive symptoms which are felt by the women are, Presence of increase level of Human Chorionic Gonadotrophin (hGc) in blood and urine. Missed menstrual period, bleeding occurs at the implantation site of embryo in the uterus. Increased body temperature sustained over two weeks over ovulation.

·     Chadwick sign: Darkening of vagina, cervix, and vulva.

·     Goo dell’s Sign: Softening of vaginal portion of cervix.

·     Hegron’s Sign: Softening of uterus/isthmus.

·     Linea Nigra: (darkling of skin in midline of abdomen caused by pigmentation.

·  Breast Tenderness: is concerned especially in young woman during first trimester.

Pregnancy Symptoms

·  General Symptoms. Major symptoms which the patient will feel during pregnancy are: Tiredness, Braxton hicks’ contractions, edema, and increase urinary frequency, urinary tract infection, and varicose vein.

·     Gastrointestinal Symptoms: Constipation due to increase level of progesterone, Hemorrhoids, Regurgitation, heart burn, nausea are common symptoms during pregnancy.

·    Skin. Striae gravidarum, (pregnancy related stretch) this mark occurs in 50 %  of the women.

·     Musclosketal Pain. Back ache, Pelvic girdle pain, Round ligament pain, Carpel tunnel syndrome are common symptoms.

Pregnancy Tests

Various test can be used which can detect pregnancy 12 days after    implantations.

•  Blood Test can  determinate the date of the embryo which has conceived.

·     Progesterone level: can also assess the fetal.

·    Ultra sonogram: can determine the age of fetus/embryo.

• The expected day of delivery may also be calculated from sonogram by measurement of fetus. This method is slightly more accurate.

·         Additional Obstetrics diagnosis by Ultrasound: technique can estimate the health, and presence or absence of congenital disease at an early age. Ultrasound during prenatal development can help to determine the due date of gestation after 24 weeks.

Pregnancy Week by Week

Pregnancy can be divided into three trimester of 14 weeks each resulting in duration of 42 weeks.

First Trimester: The placenta is partly formed from the uterine endometrium called deciduas , outer layer of  embryo develops  into umbilical cord which plays a major  role  in exchange  of  gases between fetus  and  uterine  wall.

1. In first two week of first trimester is counted for pregnancy although the pregnancy has not taken and women last menstrual is kept in consideration.
2. During third week of gestation fertilization takes place, in 4^th Week the ova is implanted in the uterus and fecundated takes place .
3. In 5^th week outline of  various parts of the  body organ heart, brain spinal cord are formed. The embryo is differentiated into three layers ectoderm, is the outer layer from which the skin peripheral nerves and central nervous system eye and internal ear are developed. The middle layer which is called mesoderm,  which forms  the heart and circulatory system  in addition to this  muscular tissue and  bone  formation and  kidney  takes  place from this  layer respectively. The inner layer of embryo is endoderm which mainly develops in to lungs intestine, bladder. The size of the embryo at 5 week is 1.6 to 3.2 mm in length.
4. In 6 week facial feature and limbs (arms and legs), start growing The movement starts  in 6^th week to 7^th week .
5. In 8^th to 11 week toe, neck, and  genital develops .The  fetus weigh 28 g(one  ounce) and length of  fetus is 76 cms . The birth defect and  ratio of  miscarriage is  reduced due to  the  increase  level of  progesterone and  minute  Volume  increase to 40%.

·         Second Trimester: is from 13 weeks to 28 weeks of pregnancy. The women feel better in this trimester as compared to the first trimester. The symptom of morning sickness reduces .The uterus and muscular increase twenty times. The fetus takes normal shape and the movement starts appearing and is term as “quickening”. The placenta becomes fully functional produce hormone and the fetus at this stage can urinate. The reproductive organ of the fetus can distinguish as male and female.

·         Third Trimester: Last trimester which starts from 29-42 weeks, there is finally weight gain throughout the pregnancy .the fetus grow more rapidly and weight may be gained up to 28 g per day. In the second trimester the women belly is upright but in third trimester it is directed downward.  The fetal movement become strong .The navel will become convex, propping out and directed slightly downward. The movement of fetus down ward results in the pressure on bladder causing weak bladder control and backache. Fetal movement becomes stronger and more frequent via improved brain eye and muscle functions. The head descend in the pelvic cavity. The premium and cervix flattened and the head is felt vaginally. The head engagement is known as colloquially. The engagement  of head in the  pelvis  reduces  the  pressure  in upper abdomen  and  the mother is  able to breathe .The bladder capacity is reduced and  increases the pressure in pelvic  floor and  rectum.  During  third trimester maternal activities  and  sleep position may affect the fetal development due  to restriction  of  blood  flow  by compressing  the inferiorvenacava. The left lateral position provide better oxygenated to infants.

 Physiological changes in Mother during Pregnancy

 Due to stress of pregnancy the women undergo certain physiological changes in cardiovascular, hematological, metabolic, renal and respiratory system. The body must change it physiological mechanisms in pregnancy to ensure the fetus is provided with an increase in blood sugar level, breathing and cardiac output are increased respectively. Level of progesterone and estrogens are continuously increased resulting in suppression of hypothalamus axis and subsequent menstrual cycle.

 Management of Pregnancy

The main aim is  to provide  , Prenatal Medical and  nursing  care  before and  during  pregnancy so that potential problems are  identified and  timely specialist advice and hospital referral is  made for safety of  the mother and fetus.

• Diet Balanced diet is  an important  factor  in healthy pregnancy Special attention is  made  regarding  the intake vitamins supplement  which are essentially required for the fetus  Absence  of  folic acid  may result  in the  neural defects. Certain essential fatty acid  like DHA-Omega-3 which is  commonly found  in breast milk is  the  major  structural fatty acid  in development  of  brain and  retina. Average weight gain during pregnancy is 11.3-15 Kg.

• Exposure to Toxin: Certain precautionary measures to be taken regarding toxin during  pregnancy, specially organic toxins like, polychlorinatedbiphenyl, organchlorine, pesticide, Perflourinated, compound, Phenols, Polybrominateddiphyenly, ether, Alcohol infestation results in birth defects, mercury and methyl mercury poses risk to pregnancy

• Air Pollution: can negatively affect the pregnancy result in higher rate of pre term birth defect and growth restriction. The nervous system of the fetus is vulnerable to lead toxicity.

• Exercise: Regular Aerobic exercise is advised for maintenance and physical fitness.

Complications

Pregnancy may induce Hypertension, Postpartum psychosis, Thrombocytopenia, Anemia, Thromboembolic disorder.

Concomitant Diseases during Pregnancy

Diseases which are  not  caused by pregnancy but  are aggravated due  to pregnancy which are Diabetes Mellitus of  pregnancy, Systematic Lupus erythermatous and  pregnancy, Thyroid disease and  Hypercoagubility disease in pregnancy respectively.

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