PregnancyPregnancyPregnancyPregnancy

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Sr. Siti Norhaiza HadzirSr. Siti Norhaiza Hadzir

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

• Prolactin secretion increased after eight weeks of pregnancy

• Prolactin, estrogen and progesteron stimulates breast development

• High plasma estrogen inhibit milk production

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.

                                                                                                                                                                               

             

• 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.

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

• The effect of pressure to the abdomen

Veracious veinRenal hypertensiongastritis (slowing in motility)Leg edema

• Increase in the rate of metabolism• Decrease GIT motility– constipation,

nausea, vomiting • Skin-chloasma, linea alba, striae,

• Fat deposition especially triglyceride

• Hypervolemia• Increase in erytropoiesis

Monitoring pregnancy

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

pregnancy

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

• 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

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

• Avoid– Specimen contaminated with

maternal, or fetal blood and urine– Not fresh

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

• Assessment of fetomaternal blood group incompatibility– Measure fetus bilirubin

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)

Pregnancy and Pregnancy and diseasedisease

Pregnancy and Pregnancy and diseasedisease

Pregnancy induced Pregnancy induced hypertensionhypertension

Pregnancy induced Pregnancy induced hypertensionhypertension

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.

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.

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

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

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.

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.

GESTATIONAL GESTATIONAL DIABETESDIABETES

GESTATIONAL GESTATIONAL DIABETESDIABETES

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.

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.

• 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.

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.

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.

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

Complications to mothers

• Preeclampsia.

• Operative delivery

• Gestational diabetes in another pregnancy

• Type 2 diabetes as they get older

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.

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)

HYPEREMESIS HYPEREMESIS GRAVIDARUMGRAVIDARUMHYPEREMESIS HYPEREMESIS GRAVIDARUMGRAVIDARUM

• 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.

• The prevalence increases in molar pregnancies (hidatidiform mole) and multiple pregnancies.

• The incidence is higher in younger women than in older women

ANEMIA IN ANEMIA IN PREGNANCYPREGNANCYANEMIA IN ANEMIA IN

PREGNANCYPREGNANCY

• 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

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

• 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.

• 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.

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