2. 2
• Obstetrics
– Field of medicine that deals with pregnancy
(prenatal), delivery of the baby, and the first
six weeks after delivery (postpartum period)
• Pregnancy
– Nine calendar months or 10 lunar months
– Forty weeks or 280 days
– Divided into trimesters
• Three intervals of three months each
– Known as gestational period
Obstetrics Overview
3. 3
• Fertilization or conception
– Union of a sperm and a mature ovum
• Takes place in outer third of the fallopian tube
– Zygote
• Initial name for fertilized ovum
– Embryo
• Name of product of conception from second
through 8th
week of pregnancy
– Fetus
• Name of product of conception from 9th
week
through duration of gestational period
Pregnancy
4. 4
• Two major accessory structures of
pregnancy
– Amniotic sac
• Strong, thin-walled membranous sac that
envelops and protects the growing fetus
• Also known as the fetal membrane
• Outer layer of sac is called the chorion
• Inner layer of sac is called the amnion
• Amniotic fluid within sac cushions and protects
fetus during pregnancy
Pregnancy
5. 5
• Accessory structures of pregnancy
– Placenta
• Temporary organ of pregnancy
• Provides for fetal respiration, nutrition, excretion
• Functions as an endocrine gland by producing
hormones necessary for normal pregnancy
• Human chorionic gonadotropin (HCG), estrogen,
progesterone, and human placental lactogen
(HPL)
Pregnancy
6. 6
• Accessory structures of pregnancy
– Maternal side of placenta
• Attached to wall of uterus
• Has a “beefy” red appearance
– Fetal side of placenta
• Has shiny, slightly grayish appearance
• Contains arteries and veins that intertwine to form
umbilical cord
• Umbilical cord arises from center of placenta and
attaches to umbilicus of fetus
Pregnancy
7. 7
• Amenorrhea
– Absence of menstruation
• Menstruation stops as a result of hormonal
influence during pregnancy
• Changes in the uterus
– Small, pear-shaped organ before pregnancy
– Grows to accommodate growing fetus,
placenta, amniotic sac, and amniotic fluid
during pregnancy
Physiological
Changes During Pregnancy
8. 8
• Changes in the cervix
– Chadwick’s Sign
• Cervix and vagina take on a bluish-violet hue due
to local venous congestion
– Goodell’s Sign
• Cervix softens in consistency in preparation for
childbirth
Physiological
Changes During Pregnancy
9. 9
• Changes in the vagina
– Vagina takes on same bluish-violet hue of the
cervix during pregnancy
– Increase of glycogen in vaginal cells
• Causes increased vaginal discharge and heavy
shedding of vaginal cells
– Leukorrhea
• Thick, white vaginal discharge during pregnancy
Physiological
Changes During Pregnancy
10. 10
• Changes in breasts
– Increase in size and shape
– Nipples increase in size and become more
erect
– Areola become larger and more darkly
pigmented
• Montgomery’s tubercles become more active and
secrete substance that lubricates the nipples
Physiological
Changes During Pregnancy
11. 11
• Changes in breasts
– Colostrum is secreted
• Thin, yellowish discharge from nipples throughout
pregnancy
• Forerunner to breast milk
Physiological
Changes During Pregnancy
12. 12
• Changes in blood pressure
– May experience hypotension during second
and third trimesters (4th
– 9th
month)
– Weight of pregnant uterus presses against
descending aorta and inferior vena cava
• When woman is lying on her back (supine)
• May complain of faintness, lightheadedness, and
dizziness
Physiological
Changes During Pregnancy
13. 13
• Changes in urination
– First trimester
• Urinary frequency due to increasing size of uterus,
creates pressure on bladder
– Second trimester
• Uterus rises up out of the pelvis and pressure on
bladder is relieved
– Third trimester
• Frequency returns due to pressure of baby’s head
on the bladder
Physiological
Changes During Pregnancy
14. 14
• Changes in posture
– Waddling gait
• Manner of walking in which the feet are wide apart
and the walk resembles that of a duck
• Due to softening of pelvic joints and relaxing of
pelvic ligaments
• Pregnant woman’s center of gravity is offset
Physiological
Changes During Pregnancy
15. 15
• Changes in the skin
– Possible increased feeling of warmth and
sweating
• Due to increased activity of the sweat glands
– Possible problems with facial blemishes
• Due to increased activity of sebaceous glands
– Chloasma
• Hyperpigmentation (brown patches) seen on
forehead, cheeks, and bridge of nose
• Known as the “mask of pregnancy”
Physiological
Changes During Pregnancy
16. 16
• Changes in the skin
– Linea Nigra
• Darkened vertical midline between the fundus and
the symphysis pubis on the abdomen
– Areola
• Becomes darker as pregnancy progresses
– Stria Gravidarum
• Stretch marks on the abdomen, thighs, and breasts
that occur during pregnancy
Physiological
Changes During Pregnancy
17. 17
• Changes in weight
– Recommended weight gain during pregnancy
• Ranges from 25 to 30 pounds
– Pattern of weight gain is important
• 1st
– 3rd
month = 3 - 4 pounds total
• 4th
– 9th
month = 1 pound per week
– Critical to monitor weight gain for unexpected
increases
– Fluid retention
– Pregnancy-induced hypertension
Physiological
Changes During Pregnancy
18. 18
Signs and
Symptoms of Pregnancy
• Presumptive signs
– Expectant mother
• Suggests pregnancy but are not necessarily
positive
• Include amenorrhea, nausea and vomiting, fatigue,
urinary disturbances, and breast changes
– Quickening
• Movement of fetus felt by the mother
• Occurs around 18 – 20 weeks gestation
• Described as a faint abdominal fluttering
19. 19
Signs and
Symptoms of Pregnancy
• Probable signs
– Observable by examiner
• Much stronger indicators of pregnancy, but can be
due to other pathological conditions
• Should not be used as sole indicator of pregnancy
• Include Goodell’s sign, Chadwick’s sign, uterine
enlargement, hyperpigmentation of skin,
abdominal stria, palpation of fetal outline, positive
pregnancy tests
20. 20
Signs and
Symptoms of Pregnancy
• Probable signs
– Hegar’s sign
• Softening of the lower segment of the uterus
– Braxton Hicks contractions
• Irregular contractions of the uterus
• May occur throughout the pregnancy and are
relatively painless
21. 21
Signs and
Symptoms of Pregnancy
• Probable signs
– Ballottement
• Technique of using the examiner’s finger to tap
against the uterus, through the vagina, to cause
the fetus to “bounce” within the amniotic fluid and
feeling it rebound quickly
22. 22
Signs and
Symptoms of Pregnancy
• Positive signs
– Fetal Heartbeat
• Detected by ultrasound at approximately 10 weeks
gestation
• Detected by fetoscope at 18 to 20 weeks gestation
• Rate can vary from 120 to 180 beats per minute
23. 23
Signs and
Symptoms of Pregnancy
• Positive signs
– Identification of embryo or fetus by ultrasound
• Can be detected as early as 5 to 6 weeks with 100
percent reliability
• Provides earliest positive confirmation of a
pregnancy
– Fetal movements felt by examiner
• Palpable by physician/examiner by the second
trimester of pregnancy
24. 24
Calculation of Date of Birth
• Birth date for the baby
– Expected Date of Confinement (EDC)
– Expected Date of Delivery (EDD)
– Expected Date of Birth (EDB)
• Nagele’s rule for calculation of date
– Subtract three months from beginning of last
menstrual period (LMP)
– Add seven days to date = expected date of
delivery
25. 25
Discomforts of Pregnancy
• Temporary discomforts of pregnancy
– Backache
• Common during second and third trimester
– Edema
• Swelling of lower extremities not uncommon
– Fatigue
• Usually occurs during first trimester
26. 26
• Temporary discomforts of pregnancy
– Heartburn
• Mainly during last few weeks of pregnancy
– Hemorrhoids
• Develop as result of increasing pressure on area
– Nausea
• Usually occurs during first trimester
– Varicose veins
• Occur as result of blood pooling in the legs
Discomforts of Pregnancy
28. 28
Abortion
• Pronounced
– (ah-BOR-shun)
• Defined
– Termination of a pregnancy before the fetus
has reached a viable age, that is, an age at
which the fetus could live outside of the
uterine environment
29. 29
Abruptio Placenta
• Pronounced
– (ah-BRUP-she-oh pla-SEN-tah)
• Defined
– Premature separation of a normally implanted
placenta from the uterine wall
• After the pregnancy has passed 20 weeks
gestation or during labor
30. 30
Ectopic Pregnancy
• Pronounced
– (ek-TOP-ic PREG-nan-see)
• Defined
– Abnormal implantation of a fertilized ovum
outside of the uterine cavity
– Also called a tubal pregnancy
• Approximately 90 percent of all ectopic
pregnancies occur in the fallopian tubes
31. 31
Gestational Diabetes
• Pronounced
– (jess-TAY-shun-al diy-ah-BEE-teez)
• Defined
– Disorder in which women who are not diabetic
before pregnancy develop diabetes during the
pregnancy
• Develop an inability to metabolize carbohydrates
(glucose intolerance), with resultant hyperglycemia
32. 32
Gestational Diabetes
• Risk factors
– Obesity
– Maternal age over 30 years
– History of birthing large babies
• Usually over 10 pounds
– Family history of diabetes
– Previous, unexplained stillborn birth
– Previous birth with congenital anomalies
(defects)
33. 33
HELLP Syndrome
• Pronounced
– HELLP SIN-drom
• Defined
– Serious obstetrical complication that occurs in
approximately 10 percent of pregnant women
with pre-eclampsia or eclampsia
• HELLP stands for Hemolytic anemia, Elevated
Liver enzymes, and Low Platelet count
34. 34
HELLP Syndrome
• Early diagnosis is critical
– Any woman who presents with malaise or a
viral-type illness in third trimester of
pregnancy should be evaluated for possibility
of HELLP Syndrome
• Laboratory diagnosis necessary to confirm
HELLP syndrome
– Complete blood cell count
– Liver function tests
35. 35
• Pronounced
– (high-dah-TID-ih-form mohl)
• Defined
– Abnormal condition that begins as a
pregnancy and deviates from normal
development very early
• Diseased ovum deteriorates (not producing a
fetus)
• Chorionic villi of placenta changes to a mass of
cysts resembling a bunch of grapes
Hydatidiform Mole
36. 36
Hydatidiform Mole
• Hydatidiform mole
– Molar pregnancy
– Hydatid mole
– Growth of this mass progresses much more
rapidly than uterine growth with a normal
pregnancy
37. 37
Hyperemesis Gravidarum
• Pronounced
– (high-per-EM-eh-sis grav-ih-DAR-um)
• Defined
– Abnormal condition of pregnancy
characterized by severe vomiting that
results in maternal dehydration and weight
loss
38. 38
• Pronounced
– (in-COMP-eh-tent SER-viks)
• Defined
– Condition in which cervical os dilates before
the fetus reaches term, without labor or
uterine contractions
• Usually occurs during second trimester of
pregnancy
• Results in spontaneous abortion of fetus
Incompetent Cervix
39. 39
Placenta Previa
• Pronounced
– (plah-SEN-tah PRE-vee-ah)
• Defined
– Condition of pregnancy in which the placenta
is implanted in the lower part of the uterus
• Precedes the fetus during the birthing process
40. 40
Pregnancy-Induced
Hypertension (PID)
• Pronounced
– (PREG-nan-see induced high-per-TEN-
shun)
• Defined
– Development of hypertension during
pregnancy, in women who had normal blood
pressure readings prior to pregnancy
41. 41
• Three categories of PID
– Gestational hypertension
• Develops after 20 weeks gestation with no signs of
edema or proteinuria
– Pre-eclampsia
• Develops after 20 weeks gestation with proteinuria
or edema
– Eclampsia
• Most severe form of hypertension during
pregnancy
• Evidenced by presence of seizures
Pregnancy-Induced
Hypertension (PID)
42. 42
Rh Incompatibility
• Pronounced
– (Rh Incompatibility)
• Defined
– Incompatibility between and Rh negative
mother’s blood with her Rh positive baby’s
blood
• Causes mother’s body to develop antibodies that
will destroy the Rh positive blood
44. 44
Signs and Symptoms of Labor
• Bloody show
– Vaginal discharge that is a mixture of thick
mucus and pink or dark brown blood
• Occurs as a result of the softening, dilation, and
thinning (effacement) of the cervix in preparation
for childbirth
45. 45
Signs and Symptoms of Labor
• Braxton Hicks contractions
– Mild, irregular contractions that occur
throughout pregnancy
• Increased vaginal discharge
– Clear, nonirritating vaginal secretions
– Occurs as result of congestion of vaginal
mucosa
46. 46
Signs and Symptoms of Labor
• Lightening
– Settling of the fetal head into the pelvis
• Occurs a few weeks prior to the onset of labor
• Rupture of the amniotic sac
– Rupture of fetal membranes, releasing
amniotic fluid inside
• May result in a sudden gush of amniotic fluid
• Women may say their “water broke”
47. 47
Signs and Symptoms of Labor
• Sudden burst of energy
– Occurs in some women shortly before onset
of labor
– May have energy to do major housecleaning
duties
48. 48
False Labor
versus True Labor
Contractions (False) Contractions (True)
Irregular Regular
Not too frequent More frequent
Shorter duration Longer duration
Not too intense More intense
49. 49
Discomfort (False) Discomfort (True)
Felt in abdomen Felt in lower back
Felt in groin area Radiates to lower
abdomen
--- Feels like menstrual
cramps
False Labor
versus True Labor
50. 50
Walking (False) Walking (True)
May relieve or decrease
contractions
May strengthen
contractions
False Labor
versus True Labor
53. 53
Diagnostic Techniques,
Treatments, and Procedures
• AFP screening
– Serum screening test for birth defects such as
spina bifida, Down syndrome, and Trisomy 18
• Test is offered to pregnant women between 15 and
21 weeks gestation
54. 54
Diagnostic Techniques,
Treatments, and Procedures
• Amniocentesis
– Surgical puncture of the amniotic sac for the
purpose of removing amniotic fluid
• Cesarean section
– Surgical procedure in which the abdomen and
uterus are incised and a baby is delivered
transabdominally
55. 55
Diagnostic Techniques,
Treatments, and Procedures
• Contraction stress test
– Stress test used to evaluate ability of fetus to
tolerate stress of labor and delivery
• Also known as oxytocin challenge test
• Fetal monitoring
– Use of an electronic device to monitor fetal
heart rate and maternal uterine contractions
56. 56
• Nipple stimulation test
– Noninvasive technique that produces same
results as contraction stress test
• Pregnant woman stimulates the nipples of her
breasts by rubbing them between her fingers
• Causes natural release of oxytocin that causes
contractions of uterus
Diagnostic Techniques,
Treatments, and Procedures
57. 57
Diagnostic Techniques,
Treatments, and Procedures
• Obstetrical ultrasound
– Noninvasive procedure that uses high-
frequency sound waves to examine internal
structures and contents of the uterus
– Ultrasonography
58. 58
• Pelvic ultrasound
– Noninvasive procedure that uses high-
frequency sound waves to examine the
abdomen and pelvis
• Pelvimetry
– Process of measuring the female pelvis,
manually or by x-ray to determine its
adequacy for childbearing
Diagnostic Techniques,
Treatments, and Procedures
59. 59
• Pregnancy testing
– Tests performed on maternal urine and/or
blood to determine presence of hormone
HCG (human chorionic gonadotropin)
• HCG is detected shortly after first missed
menstrual period
Diagnostic
Techniques and Procedures
