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but a few substances to cross from the mother into

MCN LECTURE the fetus.
THE AMNIOTIC MEMBRANES – is a dual-walled
FERTILIZATION: THE BEGINNING OF PREGNANCY sac with the chorion as the outermost part and the
This is also referred to as conception, and amnion as the innermost part. The two fuse together
impregnation, it is the union of an ovum and as the pregnancy progresses and by the term, they
spermatozoon and this usually occurs in the appear to be as a single sac. They have no nerve
ampullar portion of the fallopian tube.  supply so when they spontaneously ruptures or
OVULATION is when a mature ovum is released,  it artificially neither the pregnant woman nor the fetus
would only take 24 hours to  48 hours at the most to experiences any pain
become fertilized by a spermatozoa. THE AMNIOTIC FLUID  -  the fetus continuously
What happens to the ovum if it will not be fertilized swallows this fluid and it is absorbed from the fetal
by a sperm? intestine into the fetal blood stream, at term it is
 It will atrophies and becomes nonfunctional, approximately 800-1200 ml. The most important
That's why menstruation will sets in. purpose of the amniotic fluid is to shield the fetus
Now what happens if a sperm will be around for 48- against pressure or blow to the mother’s abdomen.
72 hours? It also protects the umbilical cord from pressure thus
 The successful sperm will meet the ovum protecting the fetal oxygen supply.
and that is when fertilization takes place THE UMBILICAL CORD – is formed from the fetal
membranes, the amnion and chorion and provides a
circulatory pathway that connects the embryo to the
chorionic villi of the placenta.  Its function is to
transport oxygen and nutrients to the fetus from the
placenta  and to return waste products from the
fetus to the placenta. An umbilical cord contains
only one vein (carrying blood from the placenta to
the fetus) and two arteries (carrying blood from the
fetus back to the placenta).

PLACENTAL HORMONES OF PREGNANCY

HUMAN CHORIONIC GONADOTROPIN – This
is  the first placental hormone produced that can  be
EMBRYONIC & FETAL STRUCTURES
found in maternal blood and urine as early as the
DECIDUA OR UTERINE LINING -   after fertilization first missed period. Its purpose is to act as a fail-
the corpus luteum in the ovary continues to function safe measure to ensure the corpus luteum of the
rather than atrophies, Human Chorionic ovary continues to produce progesterone and
Gonadotropin secreted by the trophoblast cell will estrogen so the endometrium of the uterus is
cause the uterine endometrium to continue to grow maintained. It also plays a role in suppressing the
in thickness and vascularity instead of sloughing off maternal immunologic response so placental tissue
as in a usual menstrual cycle. The endometrium is is not detected and rejected as a foreign substance.
now called decidua  and it will be discarded after ESTROGEN – is often referred to as “the hormone
birth of the child. of women”. It contributes to the woman’s mammary
CHORIONIC VILLI – these resembling probing gland development in preparation for lactation and
fingers will reach out from the trophoblast cell into stimulates uterine growth to accommodate the
the uterine endometrium to begin formation of the developing fetus.
placenta. PROGESTERONE – This is often referred to as
These villi will also produce various placental “hormones that maintains pregnancy”, it is
hormones present during pregnancy which are necessary to maintain the endometrial lining of the
HCG  (Human Chorionic Gonadotropin ), HPL uterus during pregnancy. It is present in the
(human placental lactogen), estrogen and maternal serum or blood as early as 4th week of
progesterone. Later on you will learn more about pregnancy. It also prevents premature labor as it
these great hormones and their function. reduces the contractility of the uterus during
PLACENTA – It grows from a few identifiable pregnancy.
trophoblastic cells at the beginning of pregnancy , its HUMAN PLACENTAL LACTOGEN –  it is a
major function is to serve as a transport allowing all hormone with both growth promoting and lactogenic
(milk-producing properties). By 6th weeks it will be
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produced by the placenta increasing to a peak level until 5 or 6 years of age. The eye and inner
at term. It promotes mammary gland growth ear develop as a projection of the original
development in preparation for lactation and neural tube. By 24 weeks the ear is
stimulates uterine growth to accommodate the capable of responding to sounds and the
developing fetus. eyes exhibits a pupillary reaction
indicating sight is present.
ORIGIN & DEVELOPMENT OF BODY TISSUE ENDOCRINE SYSTEM
 The fetal pancreas produces insulin
needed by the fetus (insulin doesn’t cross
the placenta). The thyroid and parathyroid
glands play a vital roles in fetal metabolic
function and Calcium balance.
 The fetal adrenal glands supply a precursor
necessary for estrogen synthesis by the
placenta.
DIGESTIVE SYSTEM
 4th week of intrauterine life the digestive
CARDIOVASCULAR SYSTEM tract separates from respiratory tract and
 This is one of the first systems to become begins to grow rapidly.
functional in intrauterine life. MECONIUM – this is a collection of cellular wastes,
 16th day of life of the fetus = there is bile, fats, mucoproteins, mucopolysaccharides and
already a network of blood vessels and portion of the vernix caseosa that accumulates in
single heart tube. the intestine as early as the 16th week. Meconium is
 24th day of life of the fetus = fetal sticky in consistency and appears black or dark
heartbeat is evident. green (obtaining its color from bile pigment). The GI
 10th to 12th week of pregnancy = the fetal tract is sterile at birth because Vitamin K is
heartbeat maybe heard with a Doppler. necessary for blood clotting and is synthesized by
 After the 28th week of pregnancy = the the action of bacteria in the intestines. At 32
heart rate stabilizes and a 110 to 160 weeks gestation sucking and swallowing reflex are
beats/min is assessed. now mature but will become strong when fetus
RESPIRATORY SYSTEM reaches its term. At 36 weeks gestation, the ability
 3rd week of intrauterine life = the of the of the GI tract to secrete enzymes essential
respiratory and digestive tracts exist as a for carbohydrate and protein digestion
single tube. is present. Amylase an enzyme found in saliva that
 End of 4th week = a septum begins to is necessary for digestion of complex starches will
divide the esophagus from the trachea. only mature at 3 months after birth. Newborns also
 3 months gestation = spontaneous doesn’t have lipase an enzyme needed for fat
respiratory practice movements begins and digestion that is why breast milk is best for
continue throughout pregnancy. newborns because it can easily be digested without
 SURFACTANT = this develops at these enzymes. The liver is active throughout
approximately 24th week of pregnancy. Its intrauterine life functioning as a filter between the
primary function is to improve the infant’s incoming blood and the fetal circulation and as a
ability to maintain respirations in the deposit site for fetal stores INITIALS
AUTHOR’S such as iron and
outside environment after birth (Rojas- glycogen.
Reyes, Morley & amp; Soll 2012). MUSCULOSKELETAL SYSTEM
NERVOUS SYSTEM  First 2 weeks of life, cartilage prototypes
 3rd week of gestation = the top portion of provide position and support to the fetus.
the neural plate will differentiate into the Ossification of this cartilage into bone
neural tube which will form the CNS begins at about the 12th week and
(Central Nervous System) which is the continues all through fetal life and into
brain and spinal cord. The neural crest will adulthood.
form the PNS (Peripheral Nervous REPRODUCTIVE SYSTEM
System). All parts of the brain ( cerebrum,  A child’s sex is determined at the moment
cerebellum, pons and medulla oblongata) of conception by a spermatozoon carrying
form in utero but not completely mature at an X or a Y chromosome and can be
birth. Brain growth continues at high levels ascertained as early as 8 weeks by
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chromosomal analysis. The male or father

of the baby carries XY chromosomes, while
the mother carries an X chromosomes. The Physiological changes that occur during pregnancy
father will determine the fetal sex, if X will are the basis for the signs and symptoms used to
be paired with Y it will become XY (male confirm a pregnancy. They can be categorized as
fetus). If X will be paired with X it will local (confined to the reproductive organs) or
become XX (female fetus). The testes first systemic (affecting the entire body).
form in the abdominal cavity and do not REPRODUCTIVE SYSTEM CHANGES
descend into the scrotal sac until 34th to Reproductive tract changes are those involving the
38th week of intrauterine life. uterus, ovaries, vagina and breasts. The
URINARY SYSTEM most obvious alteration in a woman’s body during
 Kidneys are present as early as the end of pregnancy is the increase in the size of the uterus
the 4th week of intrauterine life, the to accommodate the growing fetus.
presence of kidneys does not appear to be UTERINE CHANGES
essential for life before birth because the  UTERUS – increases in size to
placenta clears the fetus of wastes accommodate the growing fetus.
products. Urine is formed by the 12th week  Length: from 6.5 cm to 32 cm Width: from
and is excreted in the amniotic fluid by the 4cm to 24 cm
16th week of gestation.  Depth: from 2.5 to 22 cm Weight: from 50g
INTEGUMENTARY SYSTEM to 1000g
 The skin of a fetus appears thin and almost BREAST CHANGES 
translucent until subcutaneous fat begins to  typical changes are feeling of fullness,
be deposited underneath it at about 36 tingling or tenderness that occurs because
weeks, skin is covered with lanugo, soft of the stimulation of the breast tissue by
downy hairs that serves as insulation to the high estrogen level in her body. As the
preserve warmth in utero as well as cream pregnancy progresses, breast size
cheese like substance vernix increases because of the growth in the
caseosa which is important for lubrication mammary alveoli and in fats deposit. The
and from keeping the skin from macerating areola of the nipple darkens and its
in utero. Both vernix and caseosa are diameter increases from about 3.5cm to
present at birth. 5cm. There is additional darkening of the
IMMUNE SYSTEM skin surrounding the areola in some
 Immunoglobulin (Ig) G maternal antibodies women, forming a secondary areola. The
cross the placenta into the fetus as early as breast will begin to be ready for the
the 20th week and certainly by the 24th secretion of milk, by the 16th
week of intrauterine life to give a fetus week colostrum, the thin watery, high
temporary passive immunity protein fluid that is the precursor of breast
against diseases for which the mother has milk can be expelled from the nipples. As
antibodies. IgA and IgM antibodies (the vascularity of the breasts increases, blue
types which develop to actively counteract veins may become prominent over the
infection ) cannot cross the placenta, their surface of the breasts. The sebaceous
presence in the newborn is a proof that the glands of the areola (Montgomery’s
fetus has been exposed to an infection. tubercles) which keep INITIALS
AUTHOR’S the nipple supple
and helps to prevent nipples from cracking
and drying during lactation, enlarge and
PHYSIOLOGICAL CHANGES OF PREGNANCY become protuberant.
ENDOCRINE SYSTEM CHANGES
 Almost all aspects of the endocrine system
increase during pregnancy in order to
support fetal growth
 PLACENTA: Produces estrogen and
progesterone (which helps maintain
pregnancy), HCG (which allows detection
of early pregnancy).
 PITUITARY GLAND: It produces increased
levels of prolactin (milk production);
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produces oxytocin which is necessary for

labor contraction.
 THYROID: Increases levels of hormones
that increase the basal metabolic rate by
20% and can lead to increase emotional
lability, perspiration, tachycardia and
palpitations.
 ADRENAL GLANDS : Increases level of
corticosteroids and aldosterone inhibits
immune response thereby preventing
rejection of fetus.
 PANCREAS: Increases insulin production
but insulin is less effective due to estrogen,
progesterone. This allows for more glucose
to be circulating in the maternal blood
stream to be available to the fetus.
INTEGUMENTARY SYSTEM CHANGES
 The uterus increases in size the abdominal
wall stretches then causes rupture and
atrophy of small segments of the
connective layer of the skin leading
to striae gravidarum in the thighs and
abdominal wall. The umbilicus also
stretches by 28th week of pregnancy and
becomes obliterated and pushed
and appears it has turned inside out
protruding as a round bump at the center of
the abdominal wall. A narrow brown line
called linea nigra may form running from
the umbilicus to the symphysis
pubis. Darkened or reddened areas may
appear on the face as well and on cheeks
and nose known as melasma or chloasma
or the “mask of pregnancy”.
RESPIRATORY SYSTEM CHANGES
 A local change that often occurs here is
congestion or stuffiness of the
nasopharynx as a response to increased
estrogen levels. Towards the end of
pregnancy the diaphragm is displaced by
as much as 4cm upward
CARDIOVASCULAR AND HEMATOLOGIC
SYSTEM CHANGESAUTHOR’S INITIALS
 Changes in the circulatory system are
extremely significant to the health of the
fetus because they determine whether
there will be adequate placental and fetal
circulation for oxygenation and nutrition.
GASTROINTESTINAL SYSTEM CHANGES
 Nausea and vomiting are experienced
earlier in pregnancy and this is the first
sensation a woman experiences with
pregnancy. It is most apparent early in the
morning on rising and if tired during the
day. It is known as morning sickness, it is
felt at the same time the HCG
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and progesterone begins to rise.  FATIGUE

GENITOURINARY SYSTEM CHANGES  General feeling of tiredness
 Like any other systems, the urinary system PROBABLE SYMPTOMS OF PREGNANCY
undergoes specific physiologic changes  CHADWICK’S SIGN
during pregnancy, including alterations in  Color change of vagina from pink
fluid retention and renal, ureter and bladder to violet
functions. These changes are due to the  GOODELL’S SIGN
following : effects of high estrogen and  Softening of the cervix
progesterone, compression to the bladder  HEGAR’S SIGN
and ureters by the growing uterus, increase  Softening of the lower uterine
blood volume to the kidneys that results to segment
increase in urine production and lastly  BALLOTTEMENT
postural influences by the pregnant  When lower uterine segment is
woman. tapped on a bimanual
MUSCULOSKELETAL SYSTEM CHANGES  examination the fetus can be felt
 Calcium and Phosphorus needs are to rise against the abdominal wall
increased during pregnancy because an  BRAXTON HICKS CONTRACTION
entire fetal skeleton must be built. The  Periodic uterine tightening occurs
ovarian hormones relaxin and placental  FETAL OUTLINE FELT BY EXAMINER
progesterone softens the woman’s pelvic
 Fetal outline can be palpated
ligaments and joints to create pliability and
through abdomen
to facilitate the passage of the baby
POSITIVE SYMPTOMS OF PREGNANCY
through the pelvis at birth.
 PRESENCE OF FETAL HEARTBEAT
IMMUNE SYSTEM CHANGES
 Presence of fetal heartbeat heard
 Immunologic competency during
through stethoscope or Doppler
pregnancy decreases , probably to prevent
 FETAL MOVEMENTS FELT BY
a woman’s body from rejecting the fetus as
EXAMINER
if it were a transplanted organ.
 An examiner can feel fetal
Immunoglobulin G (IgG) production is
movements about 20-24th weeks
decreased , that makes a woman prone to
 VISUALIZATION OF THE FETUS by
infection during pregnancy
ULTRASOUND
SYMPTOMS OF PREGNANCY  If a woman is pregnant, a
PRESUMPTIVE SYMPTOMS OF PREGNANCY characteristic ring indicating the
 AMENORRHEA gestational sac will be revealed
 Absence of menstruation and with a beating fetal heart
 MELASMA
 Dark pigment forms on face FLOW OF PRENATAL VISIT TO AN OBSTETRICIAN
 QUICKENING
 Fetal movement felt by woman
 LINEA NEGRA
 Line of dark pigment forms on the
abdomen AUTHOR’S INITIALS
 STRIAE GRAVIDARUM
 Stretchmarks form on the
abdomen
 TINGLING SENSATION in BREAST
 Feelings of tenderness, fullness,
tingling, enlargement and
darkening of areola
 NAUSEA & VOMITING
 Upon arising or when in fatigue
 FREQUENT URINATION
 Sense of being have to void more
often than usual.
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The first prenatal visit is a time to establish baseline second trimester and 12lb last trimester. Assure the
data relevant to a woman’s health and identify pregnant woman that this a lot of weight gain can
health promotion strategies that will be important at easily be lost afterwards.
every prenatal visit. This begins by obtaining a
detailed health and sexual history including
screening for the risk of teratogen (any factor that
may adversely affect the fetus) exposure as well as
any concerns a woman has about her pregnancy.
The overall purposes of prenatal care includes:
1. To establish a baseline of present health of the
mother.
2. To determine the age of gestation of the fetus.
3. To monitor maternal well being and fetal
development.
4. To identify women who are at risk in developing
maternal complications. AGE OF GESTATION (AOG)  DETERMINATION BY FUNDIC
5. Provide health education about pregnancy, HEIGHT (FH)
lactation and newborn care. A. BARTHOLOMEW – at 20 weeks, FH approximates 20
cm at the level of the umbilicus.
Women should schedule a first prenatal visit as (view  the drawing in this module)
soon as they suspect that they are pregnant, the B. McDONALD’S RULE – FH in cm x 27 = AOG in
return appointments are usually scheduled every 4 months. 
weeks. C. EXPECTED DATE OF CONFINEMENT (EDC)
LMP + 7 days – 3 months + 1 year 
MEASUREMENT OF FUNDAL HEIGHT & FETAL
HEART SOUNDS OBSTERIC HISTORY TERMS
12-14w.= UTERUS IS PALPABLE OVER THE are important in the conduction of maternal health history
SYMPHYSIS PUBIS. during the first prenatal visit GRAVIDA is the state of
20-22w. UTERUS IS AT THE LEVEL OF THE being pregnant and the total number of
UMBILICUS. pregnancies including present pregnancy PARA is the
36w. UTERUS AT THE XIPHOID PROCESS OF number of pregnancies reaching the age of viability (the
THE STERNUM. earliest age at which fetuses survive if they are born is
4CM DOWN THE XIPHOID = WHEN generally accepted at 24 weeks or at the point a fetus
"LIGTHENING" OCCURS. weighs more than 500-600 grams ) whether infants were
MEASURE THE FUNDAL HEIGHT (FROM THE born alive or not.
TOP NOTCH OF THE SYMPHYSIS PUBIS TO THE G-gravida; the current pregnancy T-term, number of full
SUPERIOR ASPECT OF THE FUNDUS). term infants born at 37 weeks age of gestation and
AUSCULTATE FOR THE FETAL HEART SOUNDS beyond P-preterm, number of preterm infants born
(110 TO 160 BEATS/MIN) IS THE NORMAL FETAL (infants born before 37 weeks) A-abortions, the number
HEART BEAT. of pregnancies ending before 24 weeks L-living, it is
BASELINE HEIGHT/WEIGHT AND VS. the number of living children.
MEASUREMENT HEIGHT/WEIGHT, BMI, VS = BP,
RR, PR AUTHOR’S INITIALS
HEIGHT/WEIGHT, BMI, VS = BP, RR, PR
ASSESSMENT OF BODY SYSTEMS
GENERAL SURVEY
HEAD TO TOE ASSESSMENT

ASSESSING MATERNAL WEIGHT GAIN

WEIGHT GAIN in pregnancy occurs from both fetal
growth and an accumulation of maternal stores and
increases by 1.5lb per month during the first
trimester and 1lb per week during the last two
trimesters. To summarize the weight increases there
is an approximately 4.5lb during first trimester, 12lb
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 Refers to a potentially severe and even

fatal elevation of blood pressure that
PREPARATION FOR LABOR AND DELIVERY occurs during pregnancy.
Major approaches to prepare childbirth – pregnant Increased or decreased fetal movement
couples are taught about anatomy, pregnancy,  Fetal kick is usually done for monitoring
labour and delivery, relaxation techniques, breathing
exercises, hygiene, diet, comfort measures ( sacral Increased or decreased fetal movement
pressure and effleurage ).  Ask the woman about typical fetal
GRANTLY DICK READ METHOD movements and whether she has noticed
 Fear leads to tension and tension leads to any increase or decrease in this rate
pain recently.
LAMAZE METHOD  Emphasize the need for a woman to report
 Psycho prophylactic method based on any changes she notices so that further
stimulus response and conditioning. testing and follow-up can be done.
Classes on or after the 26th week up to Pregnancy- Induced Hypertension
end.  SYMPTOMS THAT SIGNALS PIH IS
LEBOYER METHOD DEVELOPING
 Lights are dimmed, room is warm with  a. RAPID WEIGHT GAIN
minimum of noise. Skin-to-skin contact is Rapid weight gain (over 2 lb per
initiated immediately after delivery week in the second trimester, 1 lb
per week in the third trimester)
 b. Swelling of the face or fingers
 c. Flashes of light or dots before
The eyes
 d. Dimness or blurring of vision
 d. Severe, continuous headache
 e. Decreased urine output

NURSING CONSIDERATIONS IN THE MANAGEMENT OF

PREGNANCY INDUCED HYPERTENSION
Visual disturbances
 Visual disturbances or continuous headaches
may signal cerebral edema or acute
hypertension
Be certain a woman is not reporting symptoms She
DANGER SIGNS OF PREGNANCY had before she became pregnant.
Vaginal Bleeding If she had the same visual and difficulties and
 Early onset or spotting of bleeding should headaches Before pregnancy as she is reporting
be reported to the Obstetrician As soon as now, she may need to see an Ophthalmologist
possible rather than her Obstetrician to help her with the
Persistent Vomiting problem
 A vomiting which occurs 3-4 times a day
and almost results to a lost in weight on the AUTHOR’S INITIALS
Promote bed rest and quiet environment
pregnant woman of 10lbs Ensure high protein intake ( 1 g/kg/day)
Chills and fever Anti-hypertensive drugs ( Hydralazine) Apresoline
 Any fever during pregnancy should also be Convulsions ( Magnesium Sulfate )
reported to the Obstetrician as soon as Evaluate physical Parameters
possible Blood Pressure, urine output
Sudden escape of clear fluid from the vagina Respiration, Patellar reflexes
 Another danger signal that should be taken
into immediate action or consideration. Myths about Pregnancy
Abdominal or chest pain
 Any signs of this can be fatal to the
pregnant woman
Pregnancy Induced Hypertension
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MYTHS
Mom’s belly reveals baby’s gender
Cocoa butter prevents stretch marks
Pregnant mother should avoid cats
Moms can give colds to their developing babies
Pregnant women should not wear heels
Exercise during pregnancy can Strangle the baby
Skipping breakfast starves the baby
Pregnant women should avoid rock concerts
Pregnant women should not dye hair
Sex during pregnancy hurts the baby
Pregnant women shouldn’t fly

AUTHOR’S INITIALS