Pregnancy

PREGNANCY

Take a journey with us from the moment a single sperm fertilizes an egg. From tiny egg to growing embryo, follow the incredible process of conception.

Ovulation happens each month when one of a woman's two ovaries releases a mature egg. It happens about two weeks after the first day of her last menstrual period.

After the egg is released from the ovary, it travels into the fallopian tube. It stays there until a single sperm fertilizes it.

A man may ejaculate 40 million to150 million sperm, which start swimming upstream toward the fallopian tubes on their mission to fertilize an egg. Fast-swimming sperm can reach the egg in a half an hour, while others may take days. The sperm can live up to 48-72 hours. Only a few hundred will even come close to the egg, because of the many natural barriers that exist in a woman's body.

It takes about 24 hours for a sperm cell to fertilize an egg. When the sperm penetrates the egg, the surface of the egg changes so that no other sperm can enter. At the moment of fertilization, the baby's genetic makeup is complete, including whether it's a boy or girl.

The fertilized egg starts growing fast, dividing into many cells. It leaves the fallopian tube and enters the uterus three to four days after fertilization. In rare cases, the fertilized egg does not leave the fallopian tube. This is called a tubal pregnancy or ectopic pregnancy and is a danger to the mother.

After it gets to the uterus, the fertilized egg attaches to the lining of the uterus, or endometrium. This process is called implantation. The cells keep dividing.

Within about a week of conception, a hormone called human chorionic gonadotropin (hCG) can be found in the mother's blood. It is produced by cells that will become the placenta. The hormone will show up on a blood or urine pregnancy test at the doctor's office. But it usually takes three to four weeks for levels of hCG to be high enough to be detected by home pregnancy tests.

Conception

Development at 8 Weeks

Development at 16 Weeks

Time for an Ultrasound

Development at 28 Weeks

Development at 36 Weeks

a. Amenorrhea (Cessation of Menstruation).

b. Nausea and Vomiting (Morning

Sickness).

c. Frequent Urination.

d. Breast Changes

e. Vaginal Changes

f. Quickening (Feeling of Life).

g. Skin Changes

h. Fatigue

i. Positive Home Test.

a. Uterine Changes.

b. Abdominal Changes.

c. Cervical Changes.

d. Basal Body Temperature

e. Positive Pregnancy Test by the

Physician.

f. Fetal Palpation

Figure 3-5. Detecting fetal heartbeat.

Doppler

a. Fetal Heart Sounds.

b. Ultrasound Scanning of the Fetus.

c. Palpation of the Entire Fetus.

d. Palpation of Fetal Movement.

e. X-ray

f. Actual Delivery of An Infant

FIRST TRIMESTER OF PREGNANCY

a. Displays a Sense of Ambivalence to the Pregnancy.

b. Fantasize About The Pregnancy.

c. Role Playing.

d. Increased Concern For Financial and Social Problems.

e. Decreased Interest In Sex Due To Bodily Changes.

a. The patient develops a sense of well-being.

b. "Quickening" is experienced.

c. The fetus heartbeat is heard.

d. Both parents develop an interest in fetal growth and development.

e. The interest in processes of labor and delivery is expressed.

f. The patient may have wide mood swings.

g. The patient may have a tendency to introvert or to focus on herself as the center of attention.

h. Changes in sexuality.

Altered Self-Image.

Fear

Aggravation

Fatigue

Obsession

Wondering

Changes Of The Skin During Pregnancy

a. Linea Nigra.

b. Mask of Pregnancy (Chloasma).

c. Striae Gravidarum (Stretch Marks).

d. Sweat Glands.

In early pregnancy, the breast may feel full or tingle, and increase in size as pregnancy progresses.

The areola of the nipples darken and the diameter increases.

The Montgomery's glands (the sebaceous glands of the areola) enlarge and tend to protrude.

The surface vessels of the breast may become visible due to increased circulation and turns to a bluish tint to the breasts.

By the 16th week (2nd trimester) the breasts begin to produce colostrum.

a. Blood Volume.

b. Cardiac Output.

c. Blood Pressure.

d. Venous Return.

a. The respiratory rate rises to 18 to 20 to compensate for increased maternal oxygen consumption, which is needed for demands of the uterus, the placenta, and the fetus.

b. Women may feel out of breath and may need to sit a moment to catch their breath.

a. A slight increase in body temperature in early pregnancy is noted. The temperature returns to normal at about the 16th week of gestation.

b. The patient may feel warmer or experience "hot flashes" caused by increased hormonal level and basal metabolic rate.

a. There is an increase in urinary output and a decrease in the specific gravity.

b. The patient may develop urine stasis and pyelonephritis in the right kidney.

c. Frequent urination is a complaint during the first through third trimester.

a. There is a realignment of the spinal curvatures during pregnancy to maintain balance (see figure 5-3).

Figure 5-3. Postural changes during pregnancy

b. There is a slight relaxation and increased mobility of the pelvic joints, which allows stretching at the time of delivery of the infant.

CHANGES OF THE GASTROINTESTINAL SYSTEM DURING PREGNANCY

a. As the pregnancy progresses, the uterus enlarges. It rises up and out of the pelvic cavity. This action displaces the stomach, intestines, and other adjacent organs.

b. Peristalsis is slowed because of the production of the hormone progesterone, which decreases tone and mobility of smooth muscles.

a. Parathyroid Gland.

b. Posterior Pituitary.

c. Anterior Pituitary.

d. Placenta.

a. Normal weight gain is about 24 to 30 pounds during pregnancy.

b. Weight gain in pregnancy.

c. Adequate protein intake should be emphasized to the patient for development of the healthy fetus and proper diet reviewed at each prenatal visit.

a. Instruct the patient on the importance of regularly scheduled follow-up visits (following the normal pregnancy).

b. Instruct the patient on the importance of proper nutrition.

c. Instruct the patient on the importance of proper rest and sleep.

d. Instruct the patient on the importance of exercise and fresh air.

e. Instruct the patient on precautions to take during pregnancy.

f. Instruct the patient on potential danger signs of pregnancy that would necessitate her contacting her physician and coming in.

Figure 6-5. Various degrees of placenta previa.

Figure 6-6. Various degrees of placenta abruptio.