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.
- 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.
- Missed Period. Missed Period Can be the first sign of pregnancy.
- Increased urination. You might find yourself urinating more often than usual.
- Physical Signs experienced by women during pregnancy, which are nausea and vomiting,
- Tiredness. Pregnant women feel excessive tiredness and fatigue during pregnancy
- Food Craving. Food cravings are common is common in pregnant women.
- 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.
· 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.
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.
- 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.
- During third week of gestation fertilization takes place, in 4th Week the ova is implanted in the uterus and fecundated takes place .
- In 5th 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.
- In 6 week facial feature and limbs (arms and legs), start growing The movement starts in 6th week to 7th week .
- In 8th 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.
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.