CHARACTERISTICS OF PREGNANCY AND LABOR GYNAECOLOGY OBSTETRICS IN
CHARACTERISTICS OF PREGNANCY AND LABOR GYNAECOLOGY & OBSTETRICS IN PHYSICAL THERAPY
PREGNANCY • Pregnancy, which spans 40 weeks from conception to delivery, is divided into three trimesters, with characteristic changes during each.
• 1 st trimester – (weeks 0 through 12) • 2 nd trimester – (weeks 13 through 26) • 3 rd trimester – (weeks 27 through 40)
FIRST TRIMESTER CHANGES • During the first trimester (weeks 0 through 12), the following occur: • Implantation of the fertilized ovum in the uterus occurs 7 to 10 days after fertilization. • The mother is very fatigued, urinates more frequently, and may experience nausea and/or vomiting (“morning” sickness). • Breast size may increase. • There is a relatively small weight gain of 0 to 1455 g (0 to 3 lb is normal). • Emotional changes may occur. • By the end of the 12 th week, the fetus is 6 to 7 cm long and weighs approximately 20 g (2 oz). The fetus now can kick, turn its head, and swallow and has a beating heart, but these movements are not yet felt by the mother.
SECOND TRIMESTER CHANGES • During the second trimester (weeks 13 through 26), the following occur: • The pregnancy becomes visible to others. • The mother begins to feel movement at around 20 weeks. • Most women now feel very good. Nausea and fatigue have usually disappeared. • By the end of the second trimester, the fetus is 19 to 23 cm (14 in. ) in length and weighs approximately 600 g (1 to 2 lb). • The fetus now has eyebrows, eyelashes, and fingernails
THIRD TRIMESTER CHANGES • During the third trimester (weeks 27 through 40), the following occur: • The uterus is now very large and has regular contractions, although these may be felt only occasionally. • Common complaints during the third trimester are frequent urination, back pain, leg edema and fatigue, ligament pain, shortness of breath, and constipation. • By the time of birth, the baby will be 33 to 39 cm long (16 to 19 in. ) and will weigh approximately 3400 g (7 lb, although a range of 5 to 10 lb is normal). • Although pregnancy typically lasts 40 weeks, the range of 38 to 42 weeks is considered full term.
LABOR • Regular and strong involuntary contractions of the smooth muscles of the uterus are the primary symptom of labor. • Labor is divided into three stages • True labor produces palpable changes in the cervix, which are known as effacement and dilation
• EFFACEMENT: is the shortening or thinning of cervix from a thickness of 5 cm(5 in. ) before onset of labor to the thickness of piece of paper. • DILATION: is the opening of cervix from the diameter of fingertip to approximately 10 cm (4 in. )
Labor: Stage 1 • Some women experience effacement and dilation before they are in true labor, however by the end of this stage the cervix is fully dilated, and there is no doubt a baby is about to be delivered. • Stage 1 of labor is divided into three major phases.
Cervical dilation phase: cervix dilatation __ 0 to 3 cm (almost completely efface. ) Uterine contractions occur from the top down, causing the cervix to open and pushing the fetus downward. Middle phase: cervix dilatation __ 4 to 7 cm. contractions are stronger and more regular. Transient phase cervix dilatation__ 8 to 10 cm (dilatation complete) Utrine contraction very strong and close together
Labor: stage 2 (Fetal descent & Expulsion) • Involves the pushing and expelling of the fetus. • Intra abdominal pressure is the primary force expelling the fetus; produced by voluntary contraction of the abdominal muscles and diaphragm. • Relaxation and stretching of pelvic floor during this stage are also necessary for successful vaginal delivery. • Uterine contraction may last as long as 90 sec during the stage.
Fetal Descent Position changes (cardinal movements) by the fetus allow it to pass through the pelvis and be born, 1. Engagement The greatest transverse diameter of the fetal head passes through the pelvic inlet( the superior opening of the minor pelvis) 2. Descent Continued downward progression of the fetus occur. 3. Flexion Fetal chin is brought closer to its thorax: this occurs when descending head meets resistance from the walls and floor of the pelvis and cervix
4. Internal rotation The fetus turns its occiput toward the mother’s symphysis pubis when the pubis head reaches the level of ischial spines. 5. Extension The flexed fetal head reaches the vulva; the fetus extends its head, bringing the base of occiput in direct contact with the inferior margin of maternal symphysis pubis; thus phase ends when the fetal head is deliverd. 6. External rotation the fetus rotates its occiput towards the mother’s secrum to allow the fetal shoulder to pass through the pelvis. EXPULSION The fetal anterior shoulder passes under the symphysis pubis, and rest of the body follows.
Labour: stage 3 expulsion of placenta
Labor: Stage 3 • Placental stage (expulsion of the placenta) • After delivery, the uterus continues to contract and shrink, causing the placenta to detach and be expelled. • As the uterus decreases in size, the placenta detaches from the uterine wall, blood vessels are constricted, bleeding slows. 5 -30 min after the baby is delivered • a hematoma is formed over the uterine placental site to prevent further significant blood loss; mild bleeding persists for 3 to 6 weeks after delivery. • UTERINE INVULSION • The uterus continues to contract and decrease in size for 3 to 6 weeks after delivery; the uterus always remains slightly enlarged over its prepregnant size.
And a new life begins A sign of ALLAH’s will!
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