Pregnancy

1
Pregnancy

• By
• Sr. Siti Norhaiza Hadzir

2
(No Transcript)
3
(No Transcript)
4
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

5

• Prolactin secretion increased after eight weeks
  of pregnancy
• Prolactin, estrogen and progesteron stimulates
  breast development
• High plasma estrogen inhibit milk production

6
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.

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10

• 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.

11
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

12

• 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,

13

• Fat deposition especially triglyceride
• Hypervolemia
• Increase in erytropoiesis

14
Monitoring pregnancy
15
Aim

• To detect fetus abnormality
• To monitor the progress of pregnancy

16
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

17

• 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

18
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

19

• Avoid
• Specimen contaminated with maternal, or fetal
  blood and urine
• Not fresh

20
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

21
(No Transcript)
22

• Assessment of fetomaternal blood group
  incompatibility
• Measure fetus bilirubin

23
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)

24
Pregnancy and disease
25
Pregnancy induced hypertension
26
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.

27
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.

28
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

29
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

30
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.

31

• 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.

32
GESTATIONAL DIABETES
33
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.

34
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.

35

• 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.

36
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.

37
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.

38
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

39
Complications to mothers

• Preeclampsia.
• Operative delivery
• Gestational diabetes in another pregnancy
• Type 2 diabetes as they get older

40
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.

41
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)

42
HYPEREMESIS GRAVIDARUM
43

• 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.

44

• The prevalence increases in molar pregnancies
  (hidatidiform mole) and multiple pregnancies.
• The incidence is higher in younger women than in
  older women

45
ANEMIA IN PREGNANCY
46

• 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

47
Clinical features

• being tired
• feeling weak
• pale skin
• palpitations
• breathlessness
• fainting spells

48

• 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.

49

• Taking iron supplements can often cause
  constipation, nausea and vomiting,
• Iron-Rich Foods liver
• spinach
• dried fruits
• Maximize Your Iron Absorption Taking 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.

50
Thank you