Pregnancy

Pregnancy lasts for a man usually 280 days (40 weeks, or 10 obstetric months).
A normal pregnancy. The occurrence of pregnancy and its further course related to the process of ovulation, fertilization, crushing and migration fertilized egg implantation and placentation.
Ovulation - break the walls Mature follicle and out of his oral egg (see the Menstrual cycle). Fertilization is the fusion of sperm and egg. Most often it happens in the abdominal end of one of the fallopian tubes. After fertilization occurs crushing eggs and moving it through the fallopian tubes (migration). Egg enters the uterus for about the 8th day after fertilization. By this time, the outer layer of cells fertilized eggs (trophoblast) acquires enzymatic activity, melts decidual the endometrium. It is formed an indentation which is immersed egg implantation. In the mucous membrane of the uterus by this time already are typical of the pregnancy change: the cells her stroma accumulate glycogen, increase in size (decidual cells), in the deep layers grow gland, forming a so-called spongy layer. Trophoblast forms villi. In part, turned to the wall of the uterus, hairs grow and by the fourth month of pregnancy constitute a children's place - the placenta (see). The fertilized egg is a cavity lined water shell (amnion) and containing the amniotic fluid (see). Towards the end of pregnancy, their number reaches 1 to 1.5 liters
The fruit is connected with the placenta, umbilical cord (see). In the first half of pregnancy it is freely change their position in the uterus. To 35 weeks, busy position remains relatively stable. In most cases, the fetus receives longitudinal position, i.e. its axis coincides with dlinnym of the uterus. Towards the end of pregnancy, the fetus reaches average length 50-52 cm, weight 3000-3500 g (see the Fruit).
Physiological changes in a woman's body during pregnancy. In connection with the development of the fetus in pregnant women raises a number of changes. Stop menstruation. The external genitals and the vagina become swollen, the lining of the vagina becomes bluish coloration. The size of the uterus continuously increase, changes its consistency (it becomes soft), increases the volume of the cavity. Sharply increased vascular network of cancer, its blood supply. The cervix is loosened, it becomes soft, becomes bluish tint. Outer and inner mouth of the cervix in pervoverhovnyh closed before delivery, avtomobilnyh - expanding in the last months of pregnancy.
Breasts grow, increasing their blood supply. Nipples become more prominent, on the areolas are Montgomery gland begins Department of colostrum.
During pregnancy start to operate two new glands of internal secretion: a yellow body and placenta. Yellow body that emerged after ovulation, not undergoing a reverse development, as observed during the menstrual cycle, and kept until the end of pregnancy. It secretes hormones (progesterone), contributing to the creation of conditions for the implantation of the egg and the correct course of pregnancy, reduce the excitability of muscles of the uterus.
Significant changes are occurring in the organs of internal secretion, especially in the pituitary gland.
Metabolism during pregnancy varies according to the needs of the fetus. There is an accumulation of proteins. Increases the content of neutral fats and cholesterol; there is increased deposition of fat in the milk glands, the placenta, the adrenal glands. In pregnant is an accumulation of salts (calcium, phosphorus, sodium, iron), which are then spent on building the body of the fetus. The increase in the number of sodium chloride contributes to water retention in the tissues. If the need in mineral salts are not covered in food ration, forming of the fruit consumed salt of the mother's body. This can lead to the development of caries, hypochromic anemia, intrauterine death and spontaneous abortion. Increasing need of the organism of a pregnant in vitamins a, group Century. D, E, and especially C.
Pregnancy has high requirements to all organs and systems of an organism of the woman and especially to the cardiovascular system. During pregnancy increases the total mass of blood. Blood pressure in healthy women during the second half of pregnancy may increase by 10 to 15 mm RT. Art., but should not exceed 130/80 mm RT. Art. More significant increase pressure indicates the development of late toxicosis of pregnancy (see Nephropathy pregnant). With the development of the fetus increases the need of the woman in oxygen. The kidneys are functioning in a normal pregnancy, with a larger than normal voltage. The amount of urine increases slightly. Urination is ecasino, especially at the end of pregnancy. The protein in the urine indicates pathology. Changes in the nervous system can be expressed in various vegetative disorders; in a normal pregnancy, they are slightly expressed: there salivation, nausea, and occasional vomiting, mutilated appetite and taste. Sometimes there irritability or fatigue.
With the growth of the uterus there is some stretching of the abdominal wall. On the places of highest tension of the skin can politicology pregnancy - hyperemesis gravidarum, which after birth turn into white scars and testify to the former pregnancy (Fig. 1). May cause pigmentation of skin on the face is marked characteristic pigmentation white line of the abdomen, nipples. In the subcutaneous tissue, especially in the buttocks and Breasts, there is excessive deposition of fat.
The body weight of the woman for the whole period normal pregnancy increases by approximately 15 -18%. Weight gain should not exceed 300 - 400 g per week. A more significant increase indicates pathology.
Recognition of pregnancy and monitoring of pregnant woman. All pregnant women as possible in the earliest stages of pregnancy should be carefully examined and taken into account. First of all it is necessary to establish the existence of pregnancy and its term. Diagnosis of pregnancy is based on the identification of subjective and objective signs of pregnancy. There are questionable, probable and reliable (doubtless) signs of pregnancy.
Equivocal signs (mainly subjective) - nausea, change in appetite, taste, smell, drowsiness, irritability, pigmentation of separate sites of a skin. Probable symptoms: the cessation of menstruation, some bloating mammary glands, the allocation when pressed on them colostrum, blueness of the mucous membrane of the vagina, increases of the uterus, changes its form and consistency. Already with 5-6-th week of pregnancy is determined by the increase in the size of the uterus first in the front to the rear (spherical form), and then and in the cross. The body of the uterus softened, and neck remains tight, allowing bimanual vaginal examination to bring together the fingers of both hands (when it is introduced into the vagina fingers are placed in the rear of the vault, and second-hand through the abdominal wall palmerait the uterus on its front surface) -a sign of Garvina - Hegira (Fig. 2). During the study, the uterus is somewhat decreases and becomes denser - sign Snegireva; in one corner of the uterus is celebrated dome-shaped protrusion is a sign of Piskacek (Fig. 3).
With doubts about the diagnosis is necessary to repeat the examination in a week. In some cases, can be used laboratory method of diagnostics of pregnancy (see Elgama - Condeca reaction, Galli - Mainini reaction).


Fig. 1. Strip pregnancy

Fig. 3. A Sign Of Piskacek.

Fig. 5. The height of standing of the fundus of the uterus at various stages of pregnancy (numbers indicate month of pregnancy).

Fig. 2. A Sign Of Garvina - Hegira.

Fig. 4. Where is most clearly heard the heartbeat of the fetus: 1 - at front as the first position of the head of the presentation; 2 - at the back as the first position of the head of the presentation; 3 - at front as the second position of the head of the presentation; 4 - at the back as the second position of the head of the presentation; 5 - in front the form of the first position pelvic presentation; 6 - at the back as the first position pelvic presentation; 7 - in the form of a second front position pelvic presentation; 8 - in the back of the form of the second position pelvic presentation.

Fig. 6. Measuring the length of the fruit of tasameem.


Authentic signs of pregnancy: the movement of the fetus, determined by hand or on auscultation, palpation parts of the fetus, listening to his heart sounds. These characteristics can be established not earlier than the 16th week of pregnancy; the heartbeat of the fetus are heard from 18-20 weeks. Where is most clearly heard the heartbeat of the fetus - see Fig. 4.
Determination of the term of pregnancy is based on the subjective data (time of last menstrual period and the first stirrings of the fetus) and objective (the size of the uterus and fetus). The strongest predictor of the duration of pregnancy is possible when referring women to the doctor (midwife) in the early stages of pregnancy. The value of the uterus is determined by bimanual vaginal research; the height of standing of its bottom - dimension measuring tape.
In 4 weeks of pregnancy, the value of the uterus corresponds to the size of chicken eggs, in 8 weeks - goose, 12 weeks is the average male mulakat standing fundal above the fold (Fig. 5): at the end of the fourth month of pregnancy -6 cm, at the end of the fifth - 16 cm, in the end of the sixth -20 cm (often at the level of the belly button), in the late seventh - 24-26 cm, at the end of eighth-28-30 cm (in the middle between the navel and the xiphoid process), in the late ninth - 32-34 cm (reaches xiphoid process; the navel smoothed) and at the end of the tenth month - 28 - 30 cm, i.e. as of pregnancy at the end of the eighth month (protruding navel).
Of particular importance is the determination of the duration of pregnancy at the time of granting the maternity leave (32 weeks). There are a number of schemes, leading information specific to that of pregnancy (scheme Figurnov, formula Skulsky and others). Pregnancy term is defined also by measuring tasameem length of the fetus (Fig. 6): the distance from the bottom of the uterus (gluteal the end of the fetus) to the lower pole of the head is multiplied by 2. When a large development of subcutaneous fat in the abdominal wall from the result subtract 2 see If the head is too far in the entrance of the pelvis, the measurement is carried to the top of a mother with adding to the amount of 2, see Setting the length of the fetus, divide that number by 5 and you get a pregnancy. Prospective term of delivery can be defined by time of last menstrual period (from the first day of menstruation counting back 3 calendar months and add 7 days), or by the date of the first stirrings of the fetus (add to it 20 weeks in nulliparous and 22 - in multiparous). To quickly determine the time of granting the maternity leave and the expected date of childbirth proposed special calendars of various designs and ruler. Finding the calendar (the ruler) the date of the first day of the last menstrual period, it is possible in corresponding column immediately to establish what number should provide prenatal leave and when assumed childbirth. The same calendar allows for the intended day of delivery to establish what number the postpartum women should start working with 56 - 70-day postnatal leave.
After the establishment of pregnancy during the first visit to produce measurement of height, determine the weight of the body of the pregnant woman and the size of the pelvis (see Midwifery research). Examine the heart, lungs (if necessary, refer to the doctors-specialists), measure blood pressure. Produce urine, blood (General, blood group, rhesus factor, the Wasserman). The woman is established clinical examination. It should regularly attend medical center. During pregnancy a woman should visit a doctor (midwife) at least 14-15 times. Every visit of a pregnant determine body weight, the volume of the abdomen, the height of standing of the fundus of the uterus, the fetal heart rate, blood pressure, produce urine. The study of blood produced during pregnancy 2-3 times. Every visit to the woman to specify the date of the next visit. If it is not within the specified period, it is called or visited at home (patronage pregnant).
Psycho pregnant preparation for delivery shall start from the first visits to the doctor or midwife (see labor Pain relief, psycho prepare).
The health of the pregnant woman. Normal course of pregnancy depends on adherence to a pregnant woman of rules of personal hygiene. Maintenance of cleanliness of the body is especially important. Hygienic wash the whole body with warm water and soap should be done more often than usual. Take a bath and wash in hot bath-house is not recommended, it is better to take a shower. In the morning and before bedtime pregnant woman should wash with soap) under strain warm water. The Breasts should be a daily wash and wipe dry with a rough towel.
Clothes pregnant women should be free. Bras should support but not to tighten Breasts. You cannot carry all of the garter. From the middle of pregnancy should be put on the bandage. On the nutrition of pregnant women - see Power.
A pregnant woman must not perform work connected with lifting or moving weights, with a sharp inclination of the torso, with professional hazards (see) and other Pregnant necessary daily walks, very useful walk before bedtime. The duration of sleep pregnant women should be at least 8-9 hours.
Sex should be excluded in the first 2-3 months of pregnancy and during 2-3 months before the birth.