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Pregnancy

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Pregnancy By Sr. Siti Norhaiza Hadzir Pregnancy If ovum is fertilized it may implant in endometrium The function of LH is taking over by human chorionic gonadotrophin ... – PowerPoint PPT presentation

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Title: Pregnancy


1
Pregnancy
  • By
  • Sr. Siti Norhaiza Hadzir

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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

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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.

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  • 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.

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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

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  • 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,

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  • Fat deposition especially triglyceride
  • Hypervolemia
  • Increase in erytropoiesis

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

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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

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  • 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

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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

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

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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

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  • Assessment of fetomaternal blood group
    incompatibility
  • Measure fetus bilirubin

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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)

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Pregnancy and disease
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Pregnancy induced hypertension
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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.

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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.

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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

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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

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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.

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  • 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.

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GESTATIONAL DIABETES
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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.

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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.

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  • 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.

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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.

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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.

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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

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

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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.

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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)

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HYPEREMESIS GRAVIDARUM
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  • 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.

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

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ANEMIA IN PREGNANCY
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  • 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

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

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  • 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.

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  • 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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