Pregnancy is the conception and development of an embryo or fetus inside the uterus of a female. Pregnancy can be divided into three trimesters, lasting for 9 months or an estimated 34-36 weeks. Gravida is a term commonly used to pertain to pregnancy and it refers to the number of times a women has been pregnant. Parity or para refers to the number of successful births of a woman. Embryo is used to describe a developing offspring for the first 8 weeks and fetus is used from 2 months until birth.

Signs of Pregnancy

Presumptive Signs of Pregnancy

This signs only presume the occurrence of pregnancy and is not comfirmatory.
  1. Amenorrhea or the absence of menstruation.
  2. Nausea and vomiting
  3. Increased breast sensitivity and breast changes
  4. Increased pigmentation in localized areas
  5. Constipation
  6. Frequent urination
  7. Quickening or an initial motion
  8. Abdominal enlargement

Probable Signs of Pregnancy

This signs may or may not confirm pregnancy and further tests and observation are required.
  1. Uterine enlargement
  2. Hegar’s sign or the softening of the lower uterine segment
  3. Goodel’s sign or the softening of the cervix
  4. Chadwick’s sign or the purplish discoloration of the vaginal mucosa
  5. Ballotment or rebounding upon palpation
  6. Braxton-Hicks Contraction
  7. Positive pregnancy test

Positive Signs of Pregnancy

This signs along with the presumptive and probable signs confirm pregnancy.
  1. Fetal heart tone can be auscultated
  2. Ultrasound of the fetus
  3. Palpable fetal movements

Physiological Changes During Pregnancy

Reproductive System Changes

  1. The uterus enlarges and painless contractions occur.
  2. Ovulation stops due to high levels of placental estrogen and progesterone.
  3. The vagina becomes softer, vaginal mucosa thickens, vascularity increases, and vaginal discharge increases and becomes more acidic.
  4. The breast increase in size, become full and tender, and the areola darkens. Sometimes colostrum may be excreted.
  5. The cervix softens (Goodel’s sign) and becomes congested with blood (Chadwick’s sign) proliferating glands form mucous plug.

Musculo-Skeletal System Changes

Gradual softening of pelvic ligaments and joints to facilitate passage of the fetus.

  1. Relaxation of joints
  2. Widening of symphysis pubis
  3. Waddling gait
  4. Lordosis or is known as the Pride of Pregnancy
  5. Increased back strain
  6. Leg cramps may occur from an imbalance of calcium phosphorus ratio in the body and from pressure of the uterus

Cardiovascular System Changes

  1. The mother’s heart muscle enlarges.
  2. The heart rotates upward and to the left.
  3. Stroke volume increases.
  4. Cardiac output increases as a result of the expanded vascular volume.
  5. The pulse rate increases by about 10-15 beats per minute.
  6. Peripheral vascular resistance falls under the influence of progesterone and prostaglandins.
  7. Femoral venous pressure increases.
  8. Blood pressure remains essentially the same, despite increase in the blood volume.
  9. Blood volume increases to 1200-1500 mL above pre-pregnancy values.
  10. Total red cell mass increases, however, the increase in plasma volume is even more pronounced.
  11. White blood cell count increases to to an average of 10,000 per millimeter cube.
  12. Clotting factors increase, offering protection against invading microorganisms but also increases the chance of thrombophlebitis.

Respiratory System Changes

  1. Oxygen consumption increases by about 20 percent.
  2. Dyspnea is a common occurrence.
  3. Nosebleeds and nasal stuffiness are common.
  4. The mother’s rib cage widen.
  5. Respiratory depth increases.

Gatrointestinal System Changes

Changes in the Gastrointestinal system are significant because it creates some of the discomforts of pregnancy. Most of the changes are produced by progesterone, which relaxes the muscles of the stomach and intestine.

  1. The gums appear red and swollen and bleed easier, this is caused by elevated levels of estrogen.
  2. There is reduced tone of esophageal sphincter that allows reflux of acidic stomach contents, producing heart burns.
  3. Decreased motility in the large intestine allows more water to be absorbed and may cause constipation and hemorrhoids.
  4. Increased thirst and appetite.

Urinary System Changes

  1. Increased urinary frequency on the first and third trimester because of pressure on the bladder.
  2. The Glomerular filtration rate increases by 50%.
  3. Glycosuria occurs because of the increased secretion of sugar by lowered renal threshold.
  4. Lower specific gravity as a result of increase urinary output.

Endocrine System Changes

  1. Thyroid activity is increased.
  2. HCG reaches a peak in the third month.
  3. There is secretion of oxytocin which stimulates uterine contractions coupled with the drop of progesterone that brings about labor.
  4. Uterine contractions increase in frequency and intensity culminating in fetal expulsion.

Discomforts of Pregnancy

  • Ankle Edema
  • Backache
  • Breast Tenderness
  • Constipation
  • Fatigue
  • Headache
  • Hemorrhoids
  • Leg Cramps
  • Urinary Frequency
  • Vaginal Discharge
  • Varicosities

Danger Signs of Pregnancy

  • Vaginal bleeding
  • Persistent vomiting
  • Chills and Fever
  • Sudden escape of fluid from the vagina
  • Abdominal or chest pain
  • Danger signs of Pregnancy Induced Hypertension
    1. Swelling of the face and fingers
    2. Flashes of lights or dots before the eyes
    3. Dimness or blurring of vision
    4. Severe or continuous headache

Prenatal Care

The objective of prenatal care is to reach all pregnant women, to give sufficient care, and to ensure a healthy pregnancy and a birth of a full term healthy baby.

Schedule of first visit is as soon as the woman missed her menstrual period and pregnancy is suspected .

Follow-up visit of a mother should be once a month from 1st week to the 32nd week, twice a month for the 32nd week until the 36th week, and every week from the 36th week to the 40th week.

Common Laboratory Procedures during Pregnancy

Complete Blood Count (CBC), Hemoglobin (Hgb), Urinalysis, Urine test for Protein, Random blood sugar, and Blood typing are some of the common laboratory procedures done on a pregnant client. All pregnant women shall be given tetanus toxoid immunization.

Common Prescriptions during Pregnancy

Iron supplements shall be given from the 5th month of pregnancy up to 2 month post-partum. (100-200 mg orally per day daily for 210 days).

Low–dose Vit.A supplements (10,000 IU in 2 weeks).

In areas with Malaria, 2 tablets of Chloroquine (150 mg/2 tablets every week for the duration of pregnancy).