PREGNANCY
-Lecture NotesWeeks 1 & 2Signs and Symptoms of Pregnancy:
Missed menstrual period
Nausea – with or without vomiting
Fatigue
Breast tenderness/changes
Frequent urination
Beginning of pregnancy is figured from beginning of last menstrual period.
A due date is important in pregnancy because:
*Helps doctors determine when to perform certain tests/procedures.
*Helps estimate baby’s growth and development.
Pregnancy lasts about 280 days, or 40 weeks, from beginning of last menstrual period.
Trimester- pregnancy divided into 3 periods – each about 13 weeks long
First Trimester*Baby’s body structure forms
*Organ system develops
*Most miscarriages occur
Third Trimester- most maternal problems occur – hypertension – pre-eclampsia –
gestational diabetes
Due dates are only an estimate, not an exact date.
Only one out of 20 women delivers on her due date.
Menstruation- two important cycles occur at the same time*Ovarian cycle – provides egg for fertilization
*Endometrial cycle-provides suitable site for implantation of fertilized egg inside uterus
Over-the-counter pregnancy tests are reliable and can be positive (indicate pregnancy) as early
as 10 days after conception.
Good health is one of the most important factors in your pregnancy.
Healthcare ProvidersObstetrician – specializes in pregnant women/ delivers babies
Perinatologist- specializes in high- risk pregnancies – which is 1 out of 10 pregnancies
Family Practitioner- family doctor serves as internist, gynecologist/obstetrician, and pediatrician
Certified nurse-midwives- Registered nurses with additional training/certification in nurse
midwifery. Delivers low-risk, uncomplicated pregnancies.
Board certified- trained professional – taken exams to qualify in their specific field of medicine.
Adverse affects on babyCigarette SmokingA pregnant woman who smokes 20 cigarettes (1 pack) a day inhales tobacco smoke more than
11,000 times during a normal pregnancy.
1. Increase rate of fetal death/fetal damage
2. Interferes with absorption of Vitamin B, C and Folic acid (neural tube defects)
3. Infants weigh about 7 oz. less
4. Lower IQ scores
5. Reading disorders
6. Hyperactivity
7. Increased risk of miscarriage
8. Increased chances of fetal death or death of baby soon after birth
9. Placenta abruption
10. Placenta previa
AlcoholModerate drinking has been linked to an increased chance of miscarriage.
FAS-Fetal Alcohol Syndrome
1. Growth retardation – before/after birth defect in limbs-heart-facial characteristics
2. Facial characteristics – nose upturned – short upper jaw line is flat – eyes slanted
3. Behavior problems – impaired speech – fine/gross motor functions are impaired
FAE- Fetal Alcohol Exposure – can result from very little alcohol
There is no safe level of alcohol consumption.
Week 3Fertilization – joining together of one sperm and one egg
The developing ball of cells is called a zygote.
About a week after fertilization, the blastocyst attaches to the uterine cavity (implantation)
Benefits of Pregnancy*Allergy/asthma sufferers may feel better – natural steroids produced during pregnancy helps
reduce symptoms.
*Helps protect against breast/ovarian cancer.
*Migraine headaches often disappear during 2nd and 3rd trimester.
*Endometriosis – pregnancy can stop the growth.
Week 4The implanted blastocyst is embedded more deeply into the lining of the uterus, and the
amniotic cavity, which will be filled with amniotic fluid, is starting to form.
Placenta- plays important role in hormone production and transports oxygen and nutrients.
The younger a woman is when she starts having babies, and the more pregnancies she has, the
greater the benefit.
Germ layers develop into specialized parts of the baby’s body such as various organs.
Three germ layers*Ectoderm-becomes the nervous system – brain – skin – hair
*Endoderm – develops into lining of the gastrointestinal tract – liver – pancreas – thyroid
*Mesoderm – skeleton – connective tissue – blood system – most of the muscles – urogenital
system
Teratology- study of abnormal fetal development
Exact cause/reason for birth defect is found in less than half of all cases.
Week 5Central nervous system and muscle and bone formation are beginning to take shape.
Brain/spinal cord – Baby’s skeleton is starting to form.
Ectopic pregnancy – occurs when egg implants outside the uterus – (ovary – cervix – abdomen)
95% of the time this occurs in the Fallopian tube
Occurs 1 of every 100 pregnancies.
Week 6Extremely important developmental time. Embryo most susceptible to factors that can
interfere with development.
Most malformations originate during this time.
Development1. Early brain chambers form
2. Eyes start to form
3. Limb buds appear
4. Heart tube fuse
5. Heart contractions begin
Week 7Incredible growth spurt this week.
1. Arm buds have grown longer – divided into hand segments – arm and shoulder
segments
2. Hand and foot have digital plates- where fingers and toes will be formed
3. Heart bulges from body and divides into right and left chambers
4. Primary air passages (bronchi) in the lungs are forming
5. Cerebral hemispheres (make up the brain) are growing
6. Eyes and nostrils are developing
7. Intestines are developing and bulges into umbilical cord
8. Appendix is present
9. Pancreas (produces insulin) is present
NutritionMilk - Need 3-4 glasses of skim milk a day
Strong bones and teeth for baby
Keeps woman’s bones healthy
Minerals-iron requirements increase to produce additional blood cells
Blood volume increases by 50%
Week 8Development1. Eyelids folds are forming on the face
2. Tip of nose is present
3. Ears are forming – internally/externally
4. Heart – aortic and pulmonary valves are present
5. Tubes leading from throat to functioning part of lungs are branched
6. Body’s trunk area is getting longer and straightening out
7. Elbows are present – arms and legs extend forward
8. Arms have grown longer – they bend at elbows and curve slightly over heart
Miscarriage- when the embryo or products of conception have emptied out of the uterus.
Bleeding should subside quickly, as should any pain or cramping.
Occurs in only about 15% of all pregnancies.
Threatened Miscarriage- may be presumed when there is a bloody discharge from vagina
during first half of pregnancy – the cervix remains closed
Bleeding many last days/weeks
May/may not be cramping – mild back aches
Resting in bed is about all you can do – Being active does not cause a miscarriage
About 20% of all women experience bleeding during early pregnancy but not all miscarry.
No procedure/medication can keep a woman from miscarrying
Inevitable miscarriage-rupture of membranes – dilation of cervix – passage of blood clots and
tissue
Uterus usually contracts, expelling fetus or products of conception (no embryo/fetus present)
Incomplete miscarriage-entire pregnancy may be passed at once – part of pregnancy is passed
while part remains in uterus – bleeding is heavy and continues until uterus is empty – bleeding
and cramps may persist if the miscarriage is not complete.
Missed miscarriage-women can experience a miscarriage without knowing it. A missed
miscarriage is when embryonic death has occurred but there is not any expulsion of the
embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms
and the absence of fetal heart tones found on an ultrasound.
Habitual/Recurrent miscarriage-defined as 3 or more consecutive first trimester miscarriages.
This can affect 1% of couples trying to conceive.
Dilation and curettage (D&C)-a procedure in which the doctor removes tissue from the inside
of the uterus. Dilation and curettage is used to diagnose or treat various uterine conditions. –
such as heavy bleeding – or to clear the uterine lining after a miscarriage.
To diagnose a condition- In a diagnostic D&C, the doctor takes a sample of the tissue that lines
your uterus (the endometrium) so tests can be performed on it. This is generally done when:
 Abnormal uterine bleeding
 Bleeding after menopause
 Severe menstrual pain
 Unable to get pregnant
 Doctor discovers abnormal cells during a routine test for cervical cancer
To treat a condition- in a therapeutic D&C the doctor removes the contents of the uterus. The
doctor can do this to:
 Remove a molar pregnancy, in which a tumor forms instead of a normal placenta
 Treat excessive bleeding after birth by clearing out any placenta that remains in the
uterus
 Remove cervical or uterine polyps, which are usually benign
 Remove fibroid tumors, which are benign tumors formed on the uterine wall

Clear out any tissue that remains in the uterus after a miscarriage – to prevent infection
or heavy bleeding, and to make room for a future pregnancy.
Toxoplasmosis-is an infection caused by a parasite that can threaten the health of an unborn
baby. You can get the infection from handling soil or cat litter that contains cat feces infected
with the parasite. You can also get it from eating undercooked meat from animals infected
with parasite or from uncooked foods that have come in contact with contaminated meat.
Because the majority of people with toxoplasmosis have no symptoms, it may be difficult to
know if you have been infected. When symptoms do appear, they can resemble the flu and
include fever, muscle aches, fatigue, and swollen lymph nodes.
Approximately one-half of women infected with toxoplasmosis can transmit the infection
across the placenta to their unborn baby. Infection early in the pregnancy is less likely to be
transmitted to the baby than infection later in the pregnancy. Early infection results in more
severe symptoms in the baby than a later one. Most babies infected during pregnancy show no
signs of toxoplasmosis when they are born, but they may develop learning, visual, and hearing
disabilities later in life.
If you have toxoplasmosis infection during pregnancy, there are several ways to check if the
baby is infected*The fluid around the fetus or the fetal blood can be tested for infection.
*About a third of infected babies have a problem that may be visible on an ultrasound.
*The baby’s blood can be tested after birth.
Toxoplasmosis can be treated during pregnancy with antibiotics. The earlier the infection is
identified and treated, the greater the chance of preventing infection of the unborn child. If the
child has already been infected, treatment can make the disease less severe. The baby can be
treated with drugs that are taken throughout the first year of life, and in some cases even
longer.
Week 9Baby now moves body and limbs.
Hard to distinguish between male and female
How pregnancy weight is distributed7 lbs. - maternal stores – fat – protein- other nutrients
4 lbs. - increased fluid volume
2 lbs. - breast enlargement
2 lbs.-uterus
7 ½ lbs.-baby
2 lbs.-amniotic fluids
1 ½ lbs.-placenta
Cost of having a baby – it costs a lot and cost varies from one part of the country to another
Week 10The end of the week 10 is the end of the embryonic period.
Chorionic Villus Sampling- test used to detect genetic abnormalities
Performed between 9-11th week – identifies Down syndrome
Done much earlier than amniocentesis – get results in about a week
Instrument is placed through the cervix or abdomen to remove fetal tissue from placenta.
Fetoscopy- Use a scope through abdomen to view baby inside the uterus. Corrects defect
before problem worsens, which could prevent the fetus from developing normally.
Week 11Fetal growth is rapid Crown –to-rump length doubles
 Head is almost half of baby’s entire length
 External genitalia are beginning to show distinguishing features
Ultrasound- (Sonogram)- Sound waves bounce off tissue – different tissues of body reflect
ultrasound signals differently – noninvasive – no known risks associated with it – motion can be
detected – fetal heart can be seen beating as early as 5-6 weeks – Babies body and limbs can be
seen moving as early as 4 weeks of embryonic growth (6th week of pregnancy)
Week 12Able to hear heartbeat with Doppler (magnifies sound)
Development:
 Skeletal system now has bone formation (ossification)
 Fingers and toes have separated
 Nails are growing
 External genitalia shows distinct signs of male or female
 Digestive system (small intestines) capable of producing contractions that push food
through bowels is forming
Week 13- end of 1st trimester
Fetal body growth accelerates as fetal head growth slows.
Eyes which started out on side of head move closer together on face.
Ears come to normal position on side of head.
Week 14- Fetus is the size of a fist and weighs about 1 oz.
Week 15- Fine hair called lanugos hair covers the baby’s body.
Alpha-fetoprotein testing- between the 16-18 weeks
As baby grows inside womb, it produces alpha-fetoprotein. This protein is found in increasing
amounts in the amniotic fluid. Alpha-fetoprotein crosses fetal membranes and enters
circulation. Elevated levels can indicate problems with the fetus. (spina-bifida- anencephaly –
central nervous system)
Week 16*Fine lanugos hair covers baby’s head
*Fingernails are well formed
*Arms and legs are moving
*May feel baby move at this point “Quickening”
Amniocentesis-Usually performed around 16-18 week
Ultrasound is used to find a pocket of fluid when fetus and placenta are not in the way
About 1 oz. of fluid is needed to perform certain tests – fetal cells that float in the amniotic fluid
can be grown in cultures.
Week 17Fat begins to form on the baby during this week.
Adipose tissue is important to heat production and metabolism.
Week 18Fetus in now 5-51/2” long and weighs 51/4 oz.
Week 19Hydrocephalus- Cerebral spinal fluid circulates around the brain and spinal cord. If openings
are blocked flow is restricted and this can cause hydrocephalus – enlargement of the head.
One in every 2,000 births.
Week 20When the baby is born, its skin is covered by vernix, a white substance that looks like paste.
Protects baby’s skin from amniotic fluid.
Secreted by glands in skin around the 20th week.
Week 21Swallowing a small amount of amniotic fluid is beneficial to the baby as it helps build up the
digestive system.
Meconium-Undigested debris from swallowing amniotic fluid in the fetal digestive system.
Greenish black to light brown.
Baby passes from its bowels several days/weeks before delivery, during labor or after birth.
If baby swallows fluid and inhales meconium into the lungs the baby could develop pneumonia.
Week 22Liver function – breaks down and handles bilirubin
Bilirubin-produced by breakdown of blood cells – lifespan of fetal red blood cell is shorter than
an adults- fetus produces more blood cells than adult.
Fetal liver has limited capacity to convert bilirubin than remove it from the fetal blood stream.
Bilirubin passes from fetal blood through the placenta to mom’s blood.
Jaundice-high levels of bilirubin – yellow tint to skin and eyes
Phototherapy – penetrates skin and destroys bilirubin.
Week 23Baby’s pancreas is developing necessary for hormone and insulin production.
Insulin is necessary for the body to break down and to use sugar.
Gestational Diabetes-affects 10% of all pregnancy
If this occurs with one pregnancy there is almost a 90% chance it will recur with other
pregnancies.
Causes*Mother’s body produces less insulin during pregnancy.
*Mother’s body can’t use the insulin appropriately
Both situations result in high blood sugar levels.
If left untreated mother and baby are exposed to high levels of sugar,
*Results in excessive amounts of amniotic fluid
*Premature labor because uterus becomes over distended
*Long labor because baby is large.
Week 24Amniotic fluid*Provides environment in which baby can move easily
*Cushions fetus against injury
*Regulates temperature for the body
*Provides a way of assessing health/maturity of baby
There is a maximum of 2 pints (32 oz.) at 36-38 weeks gestation.
Week 25Baby weighs 1 ½ lbs. 8.8” crown-to-rump
If baby were delivered at this time, it would have a good chance of surviving.
Week 26Baby weighs 2 lbs. – Crown-to-rump 9.2” – Baby is beginning to put weight on.
Week 27This week marks the beginning of the 3rd trimester.
Now is the time to sign up for pre-natal classes that prepare you for labor and childbirth.
Week 28Baby’s body is becoming plumper and rounder.
Weight – 2.4 lbs. – Crown-to-rump-15 3/4”
Week 29Birth weight increases with increasing number of pregnancies or the number of babies a
woman delivers.
Boys weigh more than girls.
Average baby’s birth weight at full term is 7-71/2 lbs.
Baby born between 38th-42nd weeks – Term baby – Full-term infant
Born before 38th week- Pre-term
At 42 weeks – Post term or Past date infant
Babies born prematurely usually weigh less than 5 ½ lbs.
Week 30Baby weighs – 3 lbs.
Total length-17”
Average weight gain during pregnancy is 25-33 lbs.
Week 31Intrauterine-Growth Retardation- (IUGR) - indicates newborn infant is small for gestational
age.
Confirmed by ultrasound.
Birth weight is below 10% percentile.
Healthcare provider measures you and weighs you with each visit.
Causes of IUGR Tobacco – inhibits baby’s growth
 Poor weight gain in mother-to-be – good nutrition and healthful diet are
important – don’t attempt to restrict weight gain
 Maternal blood flow problems – Pre-eclampsia or high blood pressure can have
marked effect on fetal development.
 Kidney disease
 Altitude – women who live in high altitudes are more likely to have babies that
weigh less than babies born who live in lower altitudes.
 Alcoholism – Drug use
 Multiple fetuses
 Infections in the fetus
 Maternal anemia
 Abnormalities of the umbilical cord or placenta (baby receiving less nutrition)
 History of IUGR – once deliver a small baby more likely to deliver again
Preeclampsia or Toxemia: (Pregnancy Induced Hypertension) - a condition of high blood
pressure during pregnancy. Blood pressure goes up, you retain water, and protein is found in
the urine. Preeclampsia prevents the placenta from getting enough blood. If the placenta
doesn’t get enough blood, the baby gets less oxygen and food. This can result in low birth
weight. However, the exact cause of preeclampsia is unknown.
Risks of developing preeclamsia:
*A first-time mom
*Women whose sisters or mothers had preeclampsia
*Women carrying multiple babies: teenage mothers: and women older than age 40
*Women who had high blood pressure or kidney disease prior to pregnancy
SymptomsMild- high blood pressure, water retention, protein in urine
Severe-headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting,
urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency
to bruise easily.
At each prenatal checkup the healthcare provider will check blood pressure, urine levels and
may order blood tests.
Treatment depends on how close to due date. If close to the due date and the baby has
developed enough, the health care provider will probably deliver the baby as soon as possible.
Mild preeclampsia and the baby has not reached full development the doctor will probably
recommend:
*Rest, lying on the left side to take the weight of the baby off the major blood vessels.
*Increase prenatal checkups.
*Consume less salt.
*Drink 8 glasses of water a day.
With severe preeclampsia, the doctor may try to treat with blood pressure medication until the
baby is far enough along to deliver safely.
Week 32Multiple Births -
Week 33Placental Abruption- separation of placenta from wall of uterus – 1 in every 80 births
Causes*Physical injury to mother – ex. Car accident
*Short umbilical cord
*Sudden change in size of uterus –from delivery or rupture of membranes
*Hypertension
*Dietary deficiency
*Uterine abnormality – placenta doesn’t attach properly
*Previous surgery on uterus – removal of fibroids – D&C for miscarriage
Episiotomy- incision made from vagina toward rectum during delivery to avoid undue tearing
First-degree- cuts only the skin
Second-degree-cuts skin and underlying tissue
Third-degree-cuts skin – underlining tissue – rectal sphincter (muscle that goes around the
anus)
Fourth-degree-cut goes through the three layers and the rectal mucosa
Week 34Biophysical profile-test used to examine fetus while still in the uterus
Checks fetal breathing movements – fetal body movements – fetal tone – heart rate – amount
of amniotic fluid
Labor-dilation (stretching and expanding) of the cervix
Braxton Hicks-many women begin to experience Braxton Hicks contractions during the last
several weeks of pregnancy. Contractions can begin as early as the second trimester; however,
they are most common in the third trimester. Painless, non rhythmical contractions that last for
approximately 30 to 60 seconds or as long as 2 minutes. Braxton Hicks are also called “practice
contractions” because they will prepare you for the real thing, and you practice the breathing
exercises in the childbirth classes.
True labor usually starts at top of uterus and radiates over entire uterus through lower back
into pelvis.
Bloody Show-cervix stretches and dilates – mucus plug
Labor lasts approx. 14-15 hours for first pregnancies
Nonstress test-when mom is lying down a fetal monitor is put on abdomen – records baby’s
heart beat – checks how baby is tolerating inside the uterus.
Stages of LaborStage One- uterine contractions – intense – cause thinning (effacement) and dilation of the
cervix – 1st stage ends when the cervix is 10cm.
Stage Two – 10 cm until baby is delivered
Stage Three-ends with the delivery of the placenta and the membranes that surround the fetus
Contractions of uterus control bleeding.
Week 35Placenta Previa-condition where the placenta lies low in the uterus and partially or completely
covers the cervix. The placenta may separate from the uterine wall as the cervix begins to
dilate (open) during labor. Affects about 1 in 200 women in the third trimester of pregnancy.
More common in women who have had one or more of the following:
*More than one child
*A cesarean birth
*Surgery on the uterus
*Twins or triplets
Signs and symptoms vary, but the most common symptom is painless bleeding during the third
trimester.
*Premature contractions
*Baby is breech, or in transverse position
*Uterus measures larger than it should according to gestational age
Once diagnosed, bed rest is required and frequent hospital visits. Depending on the gestational
age, steroid shots may be given to help mature the baby’s lungs. If bleeding cannot be
controlled, an immediate cesarean delivery is usually done.
Week 36Reasons for Cesarean delivery Previous cesarean delivery – most common
 Baby too big to fit through the birth canal
 Fetal distress
 Umbilical cord compressed
 Placenta abruption/Placenta previa
Week 37Dilatation – amount of opening of the cervix
Cervix is fully open when the diameter of cervical opening measures 10cm.
Week 38Fetal monitoring –baby’s heart rate is monitored throughout labor
Postpartum Distress Syndrome- “baby blues”- associated with a short term sense of sadness
after birth which usually only last for about 2 weeks. Quite common, especially after the
excitement of pregnancy and the drama of giving birth.
Postpartum Depression- extremely serious. It should not be underestimated at any time. Seek
help as soon as possible, it can be treated and it should be treated before anything happens to
anyone. It does not always show signs right after birth and it can affect anyone.
Warning signs:
 Constantly feeling restless
 Irritability that doesn’t fade day after day
 Feelings of sadness that last more than a few hours or an entire day
 Frequent and unexplainable crying
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Persistent lack of energy
Inability to sleep despite fatigue
Weight loss/gain that is extreme
Feelings or fears that you will harm your baby
Guilt
Feelings of inadequacy
Excessive anger
Lack of interest in your newborn
Intrusive thoughts
Week 39Breastfeeding:
*Contains all nutrients baby needs during first month.
*Protection against infection – builds antibodies
*Baby less likely to get colds and infections.
*Encourages tooth and jaw formation.
*Decreased cost.
*Mom regains figure easier.
Epidural Block- regional block administered by an anesthesiologist
After placenta is delivered, the mother may be given pitocin to contract the uterus.
Cord-Blood Banking-blood from the umbilical cord contains valuable cells that are found in the
bone marrow – stem cells that are building blocks of blood and immune systems.
Can be used to treat:
 Cancer
 Genetic diseases
 Bone marrow transplants
Frozen and cryogenically stored.
Week 40Bilirubin-breakdown product from red blood cells – increases 3-4 days after delivery and then
decreases – before baby is born; bilirubin is transferred across placental from fetus to maternal
circulation.
Jaundice-high levels of bilirubin in blood – yellowing of skin and whites of eyes
Phototherapy-light penetrates skin and destroys bilirubin
Pregnancy is considered overdue when it exceeds 42 weeks or 294 days.
While baby is growing/developing in utero it depends on important function of the placenta.
*Respiration
*Nutrition
Choosing where to give birth:
LDRP-Labor – delivery – recovery – postpartum
Remain in the same room for the entire hospital stay.
Labor-Delivery Suites-Labor in suite – moved to delivery room – go to post partum floor
Rooming/Boarding-have baby in room as long as you want
Birthing Room- deliver baby in same room as you labor in
Apgar Score-evaluation of the baby’s health after delivery. Baby is examined 1 and 5 minutes
after delivery.
*Heart rate
*Respiratory effort
*Muscle tone
*Reflex
*Color
Most babies receive a score of 7-8-9.
The goal of labor and delivery is a healthy baby.