PREGNANCY

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PREGNANCY
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Topics to be covered

• What is pregnancy?
• How to detect pregnancy
• Fetus formation
• Factors affecting fetal growth
• Factors affecting gestation
• Physical changes during pregnancy

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What is pregnancy?

• Pregnancy is the development of an embryo and
  subsequently a fetus in the uterus of a woman for
  a length of time
• During this stage, physical changes occur to the
  woman
• Pregnancy is maintained by hormones (HCG and
  Progesterone)

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Multiple pregnancy

• A pregnancy with two or more fetuses. Twins - 2
  fetuses, Triplets - 3 fetuses, Quadruplets - 4
  fetuses, Quintuplets - 5 fetuses, Sextuplets - 6
  fetuses and Septuplets - 7 fetuses
• Naturally occurring factors causing multiple
  pregnancy are
• heredity- A family history of multiple pregnancy
  increases the chances of having twins
• older age- Women over 30 have a greater chance
  of multiple conception.
• high parity-Having one or more previous
  pregnancies, especially a multiple pregnancy,
  increases the chances of having multiples.
• race-African-American women are more likely to
  have twins than any other race. Asian and Native
  Americans have the lowest twinning rates.
  Caucasian women, especially those over age 35,
  have the highest rate of higher-order multiple
  births (triplets or more).

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How to detect pregnancy?

• Urine test detect hCG
• Blood test detect hCG
• Ultrasound
• Milk test P4 (animals)
• Blood test PMSG (animals)

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Urine test

• The hCG Urine Pregnancy Test Strip is a test kit
  based on a visual, qualitative principle for the
  determination of Human Chorionic Gonadotropin (a
  glycoprotein hormone secreted by the developing
  placenta after fertilization) in urine specimens.
• Pregnancy Test Strips are over 99 accurate and
  are capable of detecting 20mIU/ml/hCG. Can test
  accurately 6 to 8 days after conceiving - and 7
  days after missed period.
• Appearance of hCG soon after conception and its
  subsequent rise in concentration during early
  gestational growth make it an excellent marker
  for the early detection of pregnancy

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hCG (Human Chorionic Gonadotrophin)

• The developing placenta begins releasing hCG into
  blood as early as 6 days after implantation. Some
  hCG also gets passed in the urine
• HCG helps to maintain pregnancy and affects the
  development of fetus
• Levels of hCG increase steadily in the first 14
  to 16 weeks following LMP, peak around the 14th
  week following LMP, and then decrease gradually
• The amount that hCG increases early in pregnancy
  can give information about pregnancy and the
  health of the baby. Shortly after delivery, hCG
  can no longer be found in the blood
• More hCG is released in a multiple pregnancy,
  such as twins or triplets, than in a single
  pregnancy
• Less hCG is released if the fertilized egg
  implants in a place other than the uterus, such
  as in a fallopian tube. This is called an ectopic
  pregnancy.

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Ultrasound

• An ultrasound test is a radiology technique,
  which uses high- frequency sound waves to produce
  images of the organs and structures of the body.
  It involve no radiation and studies have not
  revealed any adverse effects.
• The sound waves are sent through body tissues
  with a device called a transducer placed directly
  on top of the skin, which has a gel applied to
  the surface.
• The sound waves that are sent by the transducer
  through the body are then reflected by internal
  structures as "echoes." which return to the
  transducer and are transmitted electrically onto
  a viewing monitor.

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Ultrasound pictures
Week 5
Week 8
Week 11
Twins
Twins kicking
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Fetus formation

• Gene dependant
• Size dependant on nutrition and health of mother,
  parity (primiparous mothers have small babies as
  compared to multiparous mothers), mothers size,
  pregnant more than one baby and self-damage
  caused by smoking, drug addiction, alcoholism etc
• Small sized baby is due to prematurity or even if
  full-term, there must be a factor to cause a
  retarded growth for the baby

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Fetal Development

• Heart and brain develop from 3rd week
• Heart starts to pump blood from week 4-5
• Feet and hands starts to develop and tail at
  coccxy starts to shrink
• Embryo is less than an inch long at week 5
• Hands and feet is visible and nose also starts to
  form
• At week eight, it is about an inch long
• By week 9, embryo is called a fetus
• Sexual organs starts to form but sex is not yet
  determine
• Other organs also starts to form and develop
  until birth

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• Rate of fetal growth is slow until week 20 but
  accelerate to a maximum at week 30-36
• Peak of growth velocity is on week 8
• Fetal nutrition is from CHO (glucose), amino
  acids and lactate. Fatty acids, vitamins and
  minerals are also transferred to the fetus via
  the placenta

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Factors affecting fetal growth

• Genetic (species, breed, genotype)
• Environmental (nutrition, size, parity, size and
  blood circulation of placenta)
• Fetal hormones (thyroid, growth hormone,
  somatomedins)

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• Gestation length 280 days or 40 weeks or 9
  months and 10 days
• LMP Last Menstrual Period
• EDD Estimated Delivery Date (First day of last
  menstrual period plus 280 days)
• Trimester 3 months
• Human 3 trimesters

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• LMP 31/1/2009
• Menstrual cycle 28 days
• Add 40 weeks or 9 months and 10 days (280 days)
• EDD 7/11/2009 (An estimation!)

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Factors affecting gestation length

• Maternal factor age of mother
• Fetal factor number of fetuses, gender, adrenal
  and pituitary function
• Genetic species, breed, fetal genotype
• Environmental factors nutrition, temperature,
  season

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Physical changes during pregnancy

• No menstruation
• Nausea in first trimester
• Back and hip pains
• Increase in body weight
• Pigmentation of skin especially in fair-skinned
  women (cholasma mask of pregnancy) especially
  at the facial region
• Quickening or baby movements in uterus occurs
  at 5 months pregnancy onwards
• Braxton-Hicks contraction at 6-7 months
  pregnancy
• Engagement at 8 months pregnancy
• Others eg pica (Pica is a pattern of eating
  non-food materials such as dirt or paper and
  should last at least 1 month to fit the diagnosis
  of pica.)

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Back and hip pains
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Mask of pregnancy
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Development of embryo and fetus
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Abnormal pregnancies Ectopic pregnancy

• Occurs when a fertilized egg attaches somewhere
  other than in the uterus, usually in a fallopian
  tube (tubal pregnancy).
• Because an ectopic pregnancy can cause
  life-threatening complications, the pregnancy
  must be ended with medicine or surgery.
• An ectopic pregnancy, especially a tubal
  pregnancy, can be dangerous because the fallopian
  tube does not stretch as the fertilized egg
  grows. If a tubal pregnancy is not detected and
  treated early, the tube may burst. This can be a
  life-threatening situation and requires emergency
  surgery.
• Pelvic inflammatory disease or tubal surgery
  increases the risk of having an ectopic or tubal
  pregnancy by creating scar tissue that may block
  the fallopian tube.

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Abnormal pregnancies Molar pregnancy

• A mass of abnormal tissue (hydatidiform mole)
  that comes from the placenta inside the uterus,
  which triggers symptoms of pregnancy. About 1
  1,000 women with early pregnancy symptoms has a
  molar pregnancy. Two types of molar pregnancy
  complete and partial.
• Complete molar pregnancy. In place of a normal
  placenta/embryo, the hydatidiform mole is
  abnormal placental tissue that grows into a
  grapelike cluster that can fill the uterus.
• Partial molar pregnancy. The placenta grows
  abnormally into molar tissue. Any fetal tissue
  that develops is likely to have severe defects.