Chapter22 Pregnancy

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Chapter XXII

Pregnancy

Annie Grace D


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Pregnancystate of a woman who haswithin her body the

growing product of

conception or a

fecundated germ.


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Legal Importance of theStudy of Pregnancy

.Pregnancy is a ground for the

suspension of the e!ecution ofthe death sentence in a

woman.

Art. "#$ %evised Penal &ode 'he death sentence shall not be in(icwoman within the three years ne!t date of the sentence or while she is upon any person over seventy years of


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Legal Importance of theStudy of Pregnancy

.Pregnancy is a ground for the


woman.

).A conceived child is capable

of receiving donation.

Art. *+)$ &ivil &odeDonations made to conceived and unbmay be accepted by those personsregally represent them if they were alr


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Legal Importance of theStudy of Pregnancy.Pregnancy is a ground for the


woman.

).A conceived child is capable

of receiving donation.

#.A conceived child may

e!ercise civil rights.

Art. +,$ &ivil &ode-irth determines personality but tchild shall be considered born for all are favorable to it$ provided it be borncondition speci/ed in the following arti

Art. + $ &ivil &ode0or civil purposes$ the fetus is considis alive at the time it is completely d

the mother1s womb. 2owever$ if the intrauterine life of less than seven modeemed born if it dies within twenty3foits complete delivery from the materna


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Legal Importance of theStudy of Pregnancy. Pregnancy is a ground for the

suspension of the e!ecution of thedeath sentence in a woman.

). A conceived child is capable of

receiving donation.

#. A conceived child may e!ercise civil

rights.

+. &oncealment of the woman that she is

pregnant at the time of marriage is a

ground for the annulment of marriage.

Art. "4$ &ivil &odeA marriage may be annulled

following causes$ e!isting at the marriage56+7 'hat the consent of either party wby fraud$ unless such party afterwa8nowledge of the facts constitutinfreely cohabited with the other as hor his wife$ as the case may be.

Art. "9.$ &ivil &odeAny of the following circu

constitute fraud referred to in :umbpreceding article56#7 &oncealment by the wife of ththe time of the marriage$ she was prman other than her husband.:o other misrepresentation or decharacter$ ran8$ fortune or

constitute such fraud as will giveaction for the annulment of marriage.


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Instances


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Instances


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>edical =videncesof Pregnancy

Presumptive orProbable

Signs andSymptoms

Positive Signsand Symptoms

of Pregnancy


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Presumptive orProbable

Signs andSymptoms


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&essation of>enstruation

Presumptive orProbable Signsand Symptoms

Other causes that could cause cessation of menstruation:Emotional disturbance

AnemiaSystemic infectionDisturbance in the function of the ovary


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>orning Sic8ness

Other causes that could cause morning sickness:Hypertonicity of the stomachPeptic ulcerGastric hyperactivity



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>orning Sic8ness

&hanges in the-reast


ncrease in si!eSensation of tightnessPinkish bro"n areloae changed to dark#bro"n or black$ubercles of %ontgomery developed$issues erectile&olostrum found in third month


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>orning Sic8ness



'elationship bet"een age of fetus and the level of the fundus:( calendar months # ( fingers above pubic bone) calendar months # *et"een the symphysis and pubis+ calendar months # ( fingers belo" the umbilicus, calendar months # At the level of the umbilicus- calendar months # ( fingers above the umbilicus. calendar months # , fingers above the umbilicus/ calendar months # %ore than . fingers above the umbilicus

Progressive =nlargemof the Abdome



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>orning Sic8ness




&hanges in cothe vagina asoftening of

cervi!

0ac1uemin#&hadi"ck2s Sign

$here is pale violet discoloration of the anterior "all ofvaginal "all and softening of the cervi34

Hegar2s Sign*imanual e3amination of gravid uterus sho"s e3treme

softening of the cervi34

%acDonald2s SignOn account of the softening of the isthmus5 the fundus o

the uterus is antefle35 so by bimanual e3amination5 there is aneasy appro3imation of the fundus and the cervi34

Goodell2s Sign6hen the cervi3 feels as hard as the tip of the nose5

pregnancy does not e3ist5 but "hen it is as soft as the lips5the uterus is gravid4



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0unic Sou@mbilical



>orning Sic8ness





cervi!



$he "histling sound synchronous "ith the fetalheart beat4


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0unic Sou@mbilical



>orning Sic8ness





cervi!


-allottement$his is the feeling perceptible to the fingersplaced on the abdomen on giving sudden impulse tothe child through the neck of the uterus4



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0unic Sou@mbilical

-



>orning Sic8ness





cervi!


-allottement


$his is the rhythmical contraction and rela3ation ofthe uterus perceptible to the hand "hen resting on theabdomen4

nterval of contraction is +#78 min and lasting from7#+ min4


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0unic Sou@mbilical

-lad

-



>orning Sic8ness





cervi!


-allottement


9oticeable at the second month of pregnancy4 Ho"evno diagnostic value because even a non#pregnant "ommay manifest the same symptom4


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0unic Sou@mbilical

&apriciousAppetite

-lad

-



>orning Sic8ness





cervi!


-allottement


$he desire for a particular class or kind offood may sho" in "omen during the eastage of pregnancy or even thereafterHo"ever5 its presence is not conclusive ofpregnancy4


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0unic Sou@mbilical

Abnormality inPigmentation

&apriciousAppetite

-lad

-



>orning Sic8ness





cervi!


-allottement


Pregnant "omen usually manifest pigmentation insome parts of the body especially in theabdomen and perineum4Ho"ever5 pigmentation may also present in somediseases5 like Addison2s disease4


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0unic Sou@mbilical

=asy 0atigability

Abnormality inPigmentation

&apriciousAppetite

-lad

-



>orning Sic8ness





cervi!


-allottement


$his may be due to the "eight of the graviduterus and insufficiency of nutrient and o3ygensupply to the tissues if the body due to thedeviation of a portion to the gro"ing fetus4

Ho"ever5 may also present in cardiac andpulmonary diseases4


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>orning Sic8ness

=asy 0atigability

-allottement



0unic Sou@mbilical


cervi!Abnormality inPigmentation

&apriciousAppetite

-lad

-


di l id


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Positive Signs

and Symptomsof Pregnancy


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PresumProbabland Sym

2earing of the 0etal 2eartSounds 6>ayor1s Sign7

Positand S

of P

$he fetal heart sound is compared to that of theticking of the "atch under the pillo"4

ocation is at the anterior abdominal "all andis dependent upon the presentation and positionof the fetus4


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utlining of the0etal Parts

Positand S

of P

*y palpation5 "e can determine thehead5 neck5 arm5 back and buttocks4 fthese parts could be outlined5 thepregnancy is sure4Ho"ever5 it may be confused "ithirregular ovarian cyst4


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>ovement of the0etus 6Buic8ening7

Positand S

of P

Observed at the fifth month ofpregnancy5 this can be felt if thepregnant "oman and may be visible toother observers4


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C3ray =!amination


Positand S

of P

;etal skull and vertebra are visible "ith 3#ray e3amination at the fifth month ofpregnancy4Also valuable to determine the presence ofplural pregnancy5 malformation and death ofthe fetus4


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C3ray =!amination


Positand S

of P


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Laboratory 'estfor Pregnancy

.Pregnancy Slide 'esta7 Principle An agglutination3inhibition reaction is used to

demonstrate the hormone 2&G which is e!creted into theurine during pregnancy.

b7 %eagents 6 7 Pregnancy Slide 'est antiserum 6)7Pregnancy Slide 'est antigen

c7 Procedure Place drop of urine$ then drop of PS'antiserum in one of the circles on the test slide and mi!thoroughly with a stirring rod. Add drop of PS' antigen ) .>i! well with a stirring rod. &arefully agitate the slide witha circular motion ensuring that the (uid revolves all over

the circle. %ead the result after )min.d7 Interpretation of result :o agglutination means positivee7 Sensitivity 2&G concentration of .43).+ I@Eml urinef7 %emar8s 0resh urine preferably in the morning.

).Gravinde! 2&G Slide 'est3 principle and procedure involved same with thePregnancy Slide 'est


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Duration of PregnancyAverage duration is )*, )", days from the onset of last menstruation.It is hard to ascertain the e!act date of fertiliFation.

>inimum Period of Gestation &ompatible with Viability ofthe &hildA child born at ", days of gestation may live.-efore that period$ may e!hibit signs of life but cannot continue to live$ owing

the want of development of the breathing muscles and breathing center.

Abnormally Prolonged GestationIn all cases where the gestation much over #,, days is alleged$ con/rmatoryevidence should be e!pected in the e!ceptional weight and siFe of the child.

>ethods of =stimating the


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>ethods of =stimating theDate of =!pected Delivery

o 0rom the date of the /rst day of the last menstruation$ addseven days and count three months bac8wards.

o &ount forward nine calendar months from the date of the /rstday of the last menstruation and add one wee8.

o &ount forty wee8s or ten lunar months from the date of the /rstday of the last menstruation.

o Determination of the level of the fundus of the uterus.

o >easure the distance of the symphysis pubis up tothe fundus of the uterus in centimeters divided by#.4 gives the age in month of gestation 6>acDonald>ethod7.

o &ount ahead )+ wee8s in multigravidas and )) wee8s inprimagravidas from the date of the uic8ening.

Proofs of Previou


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Proofs of PreviouPregnan

Perineum is lscar if therprevious lac

0ourchette is mretrac

La!ity of the abdominalwall.

Presence of striae ofpregnancy on theabdominal wall.

Vestige only of thehymen is present

6carunculamyrtiformis7.

-reast is la! with enlarged nipples. Vaginal e!ashows p

laceratioce


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Superfecundation0ertiliFation made byseparate intercourses oftwo ova which haveescaped at the same actof ovulation.

Supatio0ertiliFa

which h

diHeren

ovulatio

Possible

decidua

united

re(e!a i


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Pseudoc

sor SpuriPregnanImaginary pregnancy usually obse

women nearing menopause or iyounger women who are very dhaving children.

Patients will present5All the sub;ective symptoms.Increase in abdominal siFe due to abdeposition or tympanism.Abnormalities with the menses.0etal movements which are in reality

agnos s o e a


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agnos s o e a

Death. %epeated e!aminations of the uterus show that the siFe remains stationary even aftera lapse of a number of wee8s or months.). =ndocrine test for pregnancy is negative on more than one occasion.

#. &essation of fetal movements after they have been felt.

+. Absence of fetal heart sounds after a repeated and prolonged e!aminatio

4. Positive signs of fetal death as shown by the palpation of softened mace

fetal head$ with bones freely moveable on each other and the scalp han

over a loose sac.

9. 'he breast cease to enlarge and become soft and (abby.

Later monthsof pregnancy


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&

Acmawmc>ay a

Chapter22 Pregnancy

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