3Ps of Implantation:

PREGNANCY  Implantation: When the fertilization is

complete, the zygote migrates over the next
3 to 4 days to the body of the uterus, with
OB Bullets: the aid of the currents triggered by the
muscular contractions of the fallopian tubes.
 PREGNANCY - has an average length for The mitotic cell division, or cleavage, begins
approximately 267 days or 38 weeks but during this time.
may vary by about two weeks in either  The first cleavage occurs at approximately
direction. 24 hours; cleavage divisions continue to
 FUNDUS - the upper, rounded portion of happen at approximately one time every 22
the uterus. It is measured from the top of the hours. When the zygote reaches the body of
mother's uterus to the top of the mother's the uterus, it is made up of 16 to 50 cells. At
pubic symphysis. Fundus is palpable above this stage, due to its bumpy outward
the level of the symphysis pubis between 12- appearance, it is called morula (from the
14 weeks, at the level of umbilicus or 20 cm Latin word morus, meaning "mulberry").
above symphysis pubis at the 20th week,  The morula continues to multiply as it floats
then rises 1 cm per week until 36 weeks. free in the uterine cavity for three or four
 GRAVIDA refers to the total number of additional days. Large cells tend to
pregnancies regardless of duration including accumulate on the periphery of the ball,
the present pregnancy. leaving a fluid space surrounding the inner
 TERM refers to the age of gestation of 38 to cell mass. At this stage, the structure is
the end of 42 weeks pregnancy. becoming a blastocyst. It is this structure
 PARITY refers to the number of past that is attached to the endometrium of the
pregnancies that have reached the period of uterus.
viability (possibility of survival outside the  The cells in the outer ring are the cells of the
uterus, at 20 weeks gestation or more than trophoblast. These are part of the system that
500 g in weight), regardless of the number will form the placenta and the membranes
of fetuses and whether the fetus was born later on. The inner cell mass (embryoblast
alive or dead. cells) is the component of the structure that
 ABORTION refers to any pregnancy that will shape the embryo.
terminates before age of viability.
Stages of Fetal Growth Development:
Fertilization:
 Within just 38 weeks, the fertilized egg
 Fertilization (also referred to as conception (ovum) matures from a single cell to a fully
and impregnation) is the union of an ovum formed fetus ready for birth. Fetal growth
and a spermatozoon. This usually occurs in and development are usually divided into
the outer third of a fallopian tube, the three periods: pre-embryonic (first 2 weeks,
ampullar portion (Crombleholme, 2009). starting with fertilization), embryonic
 Generally, only one woman's ova can (weeks 3 through 8) and fetal (week 8
achieve maturity per month. If the mature through birth).
ovum is released, fertilization must take  Milestones of Fetal Growth and
place relatively quickly because the ovum is Development: When fetal milestones occur,
capable of fertilization for only 24 hours (at they can be ambiguous, because the life of
most 48 hours). the fetus is usually estimated from the time
 After that time, it atrophies and is non- of ovulation or fertilization (ovulation age),
functional. Since the functional life of a but the length of pregnancy is more
spermatozoon is also approximately 48 generally measured from the first day of the
hours, possibly as long as 72 hours, the last menstrual cycle (gestational age).
overall critical time span during which
sexual intercourse must occur for 3 P’s of Pregnancy:
fertilization to be successful is
approximately 72 hours (48 hours before  PREGNANCY MNEMONIC
ovulation plus 24 hours after fertilization). (PRESUMPTIVE, PROBABLE, AND
 Instantly after infiltration of the ovum, the POSITIVE)
chromosomal content of the ovum and the
sperm fuse to form a zygote. PREGNANCY PRESUMPTIVE SIGNS AND
SYMPTOMS (changes felt by woman)
  “PRESUME” o These signs are present because they
speculation or unconfirmed (PMS is very can only be attributed to a FETUS.
similar to these signs) o There is no other cause. The woman
o Period absent (amenorrhea) is definitely pregnant.
o Really tired (fatigue)
o Enlarged breast
o Sore breast
o Urination increased FETUS
o Movement of fetus in uterus…
woman perceives fluttering sensation o Fetal movements felt by a doctor or
in her lower abdomen…this is nurse
referred to as “quickening” o Electronic device detects fetal
Quickening can occur at 16 weeks heart sounds (Doppler)
for 2nd time moms and around 20 o The delivery of the baby
weeks for 1st time moms o Ultrasound detects the fetus
o Emesis and nausea o See visible movement of the baby
by the doctor
PROBABLE SIGNS OF PREGNANCY (changes
observed by examiner) FETAL HEARTBEAT
 “PROBABLE” However, these signs do  Heartbeat – 12 weeks by Doppler
NOT mean 100% that a baby is growing in  Movement – felt by examiner usually at 20
the uterus. It can be due to other causes. weeks
o Positive pregnancy test  Skeleton – by Sonography or X-ray
o Returning of the fetus (ex: bouncing
back of the fetus) against the fingers Metabolic Changes during Pregnancy:
when the uterus is pushed during
palpation. This is termed as “external  Weight gain – average is 11-13 kgs. (24-28
ballottement.” lbs.)
o Outline of fetus can be palpated o Fetus: 3400gm
o Braxton Hicks Contractions: false o Placenta: 450gm
labor contractions that are not regular o Amniotic Fluid (AF): 900gm
and won’t result in cervical dilation o Uterus: 1100gm
o A softening of the cervix “Goodell’s o Breast tissue: 1400gm
Sign”…. happens around the 6-8th o Blood volume: 1800gm
week of gestation o Maternal stores: 1800-3600gm
o Bluish color to the vulva, cervix, and
o Weight gain steady & consistent
vagina due to increased blood (Ideal): total of 24-28 lbs.
flow….happens around 4 weeks  1st trimester = 2-4 lbs.
gestation- “Chadwick’s Sign”  2nd trimester = 12-14 lbs.
 3rd trimester = 8-12 lbs.
 Increase in skin pigmentation:  Water Metabolism – average woman
1. Striae Gravidarum: These are retains 6.5L of extra water during
stretch marks that appear on the pregnancy.
tummy and/or buttocks. They are  CHON Metabolism – fetus, uterus &
also sometimes present in patients maternal blood are rich in CHON.
with sudden weight gain or loss.  CHO Metabolism – human placental
2. Linea Nigra: This is a dark-colored lactogen, estrogen, progesterone, & an
line that appears on the tummy in the insulinase produced by the placenta during
midline, around and about the belly pregnancy oppose the action of insulin
button. during pregnancy/ pregnancy potentially can
3. Chloasma: This is a bronze–brown initiate Diabetes, and DM may be
discoloration that appears on the face aggravated by pregnancy.
of pregnant women especially those  Fat Metabolism – fats are more completely
with dark-colored hair. Referred to absorbed during pregnancy; plasma lipid
as the "MASK of PREGNANCY." levels increase during the 2nd half of
pregnancy.
POSITIVE SIGNS OF PREGNANCY
Determination of Estimated Birth Date:
 Positive
o means conclusive, definite, or
absolute.
  It is impossible to predict the day the child is most accurate way to measure gestational
born with a high degree of accuracy. age.
Traditionally, this date has been referred to
as the estimated date of confinement (EDC). Diagnosis of Pregnancy
Since women are no longer "confined" after
childbirth, EDB abbreviation (estimated date GTPAL System
of birth) or EDD (estimated date of delivery)
is more widely used today. Naegele’s rule is  GTPAL example calculation
the standard method used to predict the Imagine a patient who has had 2 term
length of a pregnancy (Naegele’s rule was deliveries, 1 preterm delivery, 7
named after Franz Karl Naegele, a German miscarriages, and has 2 living children.
obstetrician). o G = 10 (the patient's combined 2
term births + 1 preterm birth + 7
Naegele’s Rule: miscarriages)
o T = 2 (the patient's 2 term births)
 To calculate the date of birth by this rule, o P = 1 (the patient's 1 preterm birth)
count backward 3 calendar months from the o A = 7 (the patient's 7 miscarriages)
first day of a woman’s last menstrual period o L = 2 (the patient's 2 living children)
and add 7 days. For example, if the last
menstrual period began May 15, you would To further clarify what GTPAL means and doesn't
count back 3 months (April 15, March 15, mean, notice that the patient had a total of 3 births,
February 15) and add 7 days, to arrive at a but only has 2 living children. This patient lost their
date of birth of February 22. (Silbert-Flagg child at some point, and based on the available data,
et al., 2018) the child may have died in infancy or died at age 20
—we don't know.
Tips when using Naegele’s Rule:
Prefix meanings:
1. Do not think about using leap year. February
will always have 28 days no matter what.  Nulli: never or none
2. Each month has a different number of days,  Primi: first
so keep that in mind! April, June,  Multi: many
September, and November have 30 days (all
the rest is 31). Terms to Know:
3. Calculation is done assuming that the
woman has a menstrual cycle of 28 days.  Nullipara: a woman who has never
This does not apply to everyone, but with completed a pregnancy at 20 weeks
Naegele’s rule, we’re going to assume. gestation or greater.
4. The woman is required to have a regular  Nulligravida: a woman who has never been
menstrual cycle of 28 days. pregnant.
 Primipara: a woman who has only once
The main methods to calculate gestational completed a pregnancy at 20 weeks or
age are: greater.
 Primigravida: a woman who has been
 Directly calculating the days since the pregnant once or is currently pregnant for
beginning of the last menstrual period. the first time.
 Early obstetric ultrasound, comparing the  Multipara: a woman who has completed
size of an embryo or fetus to that of a two or more pregnancies at 20 weeks
reference group of pregnancies of known gestation or greater.
gestational age (such as calculated from last  Multigravida: a woman who has been
menstrual periods), and using the mean pregnant two or more times.
gestational age of other embryos or fetuses
of the same size. If the gestational age as Gravida and Parity Examples (Scenarios)
calculated from an early ultrasound is
contradictory to the one calculated directly  Example 1: During the health history
from the last menstrual period, it is still the collection on a female patient at a women’s
one from the early ultrasound that is used for health clinic visit, the patient tells you she is
the rest of the pregnancy. not currently pregnant but has been pregnant
 In the case of in vitro fertilization, three times before. She states that at 39
calculating days since oocyte retrieval or co- weeks gestation she gave birth to a boy.
incubation and adding 14 days. However, the other two pregnancies ended
 Ultrasound measurement in the first at 7 and 10 weeks gestation. How would you
trimester is generally considered to be the
 calculate the patient’s gravidity and parity?
Answer: Gravida 3, Para 1
Rationale: The patient is NOT currently
pregnant so we won’t count this in the
gravida. However, she has been pregnant
three times before. So, her gravida is
THREE. The patient further explains that
she has only completed ONE pregnancy at
39 weeks and the other two were completed
at 7 and 10 weeks gestation. Remember
parity is the number of pregnancies
completed at 20 weeks gestation or more.
Therefore, the patient’s parity is 1.

Example 2: a patient is pregnant with twins at 30

weeks gestation. This is her first pregnancy. How
would you calculate the patient’s gravidity and
parity?

Answer: Gravida 1, para 0

Rationale: this is the patient’s first pregnancy.

Therefore gravida is one (remember that the number
of babies is not added into the gravidity, she is still
pregnant and has not completed the pregnancy yet
therefore the parity is zero)

However let’s say she gives birth at 38 weeks

gestation to twin, what would the gravidity and
parity be now? Gravida 1, para 1 (the parity changes
since she has now completed the pregnancy… again
the para isn’t two because we don’t calculate the
number of babies.