Chapter III Pregnancy and Childbirth

Chapter 3. Pregnancy and Childbirth

General 3.1 Changes During Pregnancy
Body changes vary from woman to woman. These depend on several factors, for exam
ple, healthy women are easily adapted to the functional effects on pregnancy, wh
ile those with a weak physical condition, illness or other, can easily decompens
ation. In the latter we find malnutrition, fear, tension, stress, drug addiction
or some other pathology.
Changes 3.1.1 FisiogravÍdicos
There is another series of changes that a woman will easily detect as your pregn
ancy progresses as: 1. Body weight: The weight gain experienced approximately 20
% of normal weight to be distributed as follows: Baby Breast Growth Uterus Place
nta blood Amniotic Fluid Volume = = = = = = 1 kg 3 to 3.5 Kg 1 Kg 1 Kg 1 Kg 2 Kg
2. Gestational Age 1:
Gestation is the period between conception and birth of a baby, during which the
fetus grows and develops inside the mother's uterus. Gestational age is the tim
e measured in weeks from the first day of the last menstrual cycle of women to d
ate in which measurements are made. A pregnancy of normal gestation is approxima
tely 40 weeks, with a normal range of 38-42 weeks. Babies born before 37 weeks a
re considered premature and after 42 weeks are considered postmature.
GESTATIONAL AGE
Weeks Month
4 8 3 17 22 27 32 36 40
1 2 3 4 5 6 7 8 9
1
Source: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/002367.htm Consu
ltation: April, 2008
3. SFH: Size which is the uterus in relation to gestational age .. The following
chart shows the approximate height of the fundus during the various weeks of ge
station. It is measured in centimeters.
3.1.2 own Pregnancy Discomforts
Pregnancy is not a disease and most women will go normally, healthy and without
problems. However, we must recognize that it may be uncomfortable. Many ailments
of pregnancy are more a cause of nuisance than true concern, and if you are pre
pared for them will have won half the battle. Much of the pains of pregnancy is
due to fatigue and having to carry more weight. However, if you are worried abou
t anything, talk quietly with your doctor who will discuss any problems or conce
rns you may have and will confirm that all is well.
SYMPTOMS irritation sensation behind the breastbone and occasional regurgitation
of sour fluid. Metallic taste. It alters the taste and appeal of certain foods
such as coffee, alcohol and seasoned meals. Increased appetite for sweets. Cravi
ngs for certain foods, which sometimes even keeps you from sleeping or relaxing.
Pain in the thigh, calf and foot, so intense that it disrupts your sleep. A pai
nful knot followed by a vague pain that persists hours. Thick white discharge ac
companied by intense itching. It can cause painful urination. I want to sleep mo
re at night and at odd hours. The legs hurt and suffer with their weight at the
end of pregnancy. Obstetric cholestasis cause general itching of the skin. Other
symptoms include dark urine, pale stool and jaundice. Dizziness, instability, a
nd need to sit or lie down. Shortness of breath while exercising. Shooting pain
like a cramp when you change positions or permanent pain on one side only. TREAT
MENT Avoid foods that knows from experience that cause problems and do not eat c
lose to bedtime. Lie in bed in a semi-erect and drink a glass of warm milk. Anta
cids may be prescribed. None. Do not deprive yourself of these foods unless fat.
Very firm massage, if possible for several minutes. Also useful to flex the foo
t up and push with the heel. S cramp persists, consult your doctor, you may make
calcium tablets. You may be prescribed antifungal vaginal suppository form and
cream. In two or three days controlled the infection. If the baby is infected at
birth medical treatment will eliminate the problem quickly. Do not wear tight u
nderwear. Avoid excessive activity. Sleep or rest when you can. Eat small, frequ
ent meals to keep your energy. Retire to bed early. Ask others to do their work.
It is essential to maintain continuous medical supervision which may include fr
equent ultrasounds, blood tests and check blood flow to the placenta. Whatever t
he treatment adopted, it is considered vital to anticipate the birth, which must
take place around 37-38 weeks. Avoid standing for a long time.€Not incorporate
d quickly. Be careful when exiting the hot bath. Stay cool. I feel faint, lie do
wn without a pillow and try to raise some legs. Be less active, rest longer. Con
sult your doctor if you have chest pain or inflammation. None. The pain is usual
ly spasmodic, so not worth the pain. Hot water bag to relax the muscles.
SYMPTOMS widespread pain throughout the lumbar region. Sacroiliac pain typically
extends from the top of the buttocks down.
TREATMENT good posture and exercises for strength and flexibility to the spine.
Wear low-heeled shoes suitable. Sleep on a firm mattress. Do not lift heavy obje
cts. If the pain radiates down the leg to the foot, consult your doctor to rule
out a slipped disk. Try to avoid pain. Massages help. The pain will disappear as
soon as the baby's head fits into the pelvic cavity shortly before birth (or ea
rlier in some women, particularly in primográvidas). Try not to compress the ri
bs, lie down or lie down. Avoid standing, especially in warm weather. Rest your
legs up and at least once a day. Avoid salty foods. If edema is significant, you
r doctor may restrict the amount of salt and prescribe diuretics to remove exces
s liquid. Evacuate the intestines where the body asks for it. Eat a diet rich in
fiber and fluids, especially water. The exercise will also help. Avoid strong l
axatives. The creams and ointments are useless. Over time, stretch marks will be
come small, narrow and silver, but rarely disappear. Do not increase weight quic
kly. It can reduce fluid intake before going to bed. Try rocking while urinating
. This reduces the pressure on the bladder, allowing complete evacuation. If pai
n or blood with urination, see your doctor. Use a sunscreen when sunlight is int
ense. Never bleach your skin. The pigmentation fades a few months after delivery
. Keep these areas clean and apply a soothing lotion such as calamine. Apply tal
cum powder after bathing to make sure the skin is dry. It is essential to pay at
tention to oral and dental hygiene with regular brushing after eating. Visit you
r dentist regularly but do not forget to mention your pregnancy, you should avoi
d X-rays is not true that the fetus draws calcium from your teeth. If gingivitis
, tell your dentist immediately. If the discharge is simply an increased mucus,
do not worry. Avoid douches and vaginal deodorants not apply. Wear cotton underw
ear and change frequently, especially in warm weather. If the discharge has a co
lor, odor or spotting, tell your doctor. Use light cotton clothes and cotton und
erwear. Drink more fluids to compensate for the loss of data. If you notice any
change, consult your eye care professional. If you wear contact lenses, report i
t to the staff of the prenatal visit. You may need to discontinue its use during
pregnancy.
Acute pain and tenderness on the side, under the breasts. It is severe when it i
s sitting up straight. Swelling of hands and ankles. The ankle feels tight. Stif
fness in fingers upon awakening. Deposition rare and difficult. Pain in the lowe
r abdomen. Silver marks on the thighs, abdomen and breasts. Frequent and urgent
need to urinate, even a small amount, day and night. Darken the skin around the
nipple and areola. It forms the black line sobe abdomen. Increased pigmentation
of freckles or birthmarks. Intertrigo is a reddening of the skin that occurs whe
re the sweat provoked, usually under the breasts or groin. Sensitivity and gingi
val bleeding after brushing or chewing hard food.
Mild increase in white discharge normal and transparent, without discomfort, pai
n or irritation. Colored discharge or odor.
Perspiration with little exercise, or being bathed in sweat at night. Trouble se
eing far away or close up, and wearing contact lenses.
SYMPTOMS irritation or itching of the skin. Varicose veins appear later as purpl
e lines. Feeling of heaviness in the vulva.
TREATMENT Use tight pantyhose and put them on before getting up, after standing
with your feet up a few minutes. Sleep with your feet on a pillow. Exercise to i
mprove circulation. For variceal vulgar, sleep with her buttocks on a pillow or
use a pad to firmly tighten the inflamed area. Try not to swallow air and avoid
foods that cause flatulence.€The mint and hot drinks can help. Prevent constipa
tion and hemorrhoids with a diet high in fiber, fluids and exercise. Try not to
strain during bowel movement. Improve mild hemorrhoids after delivery, but may r
equire a cream to relieve them, keep the anal area clean to avoid irritation. If
itching is excessive ice packs applied. Try to lie on two or three pillows or u
se a firm mattress and avoid heartburn. Evacuate the bladder frequently, avoid h
eavy lifting and constipation control. Practice regularly exercises the muscles
of the pelvic floor. Drink plenty of water. See your doctor. It will also examin
e urine and antiseptics will be made specific to eradicate the infection. Wear l
ight sleep. A drink or a hot bath before bedtime can help. Read a good book. We
rarely prescribe sleeping pills, except perhaps in the third quarter, if the pro
blem has it been exhausted. Try your nose gently. Avoid dry and dusty environmen
ts. Do not use dusty agents without consulting your doctor. In case of nosebleed
, gently push the wall. Lean forward slightly. Rest, avoid violent exercise and
take a painkiller such as paracetamol, but after consulting your doctor. Eat lit
tle and often, avoid foods that cause nausea. Not too much because worsen fatigu
e, eat a good diet, suck or chew mints fruit or crackers. Drink plenty of fluids
. Talk to other women know that it is the only help. The doctor will be reluctan
t to prescribe something.
Distension, frequent gas.
noise
stomach
step
Itching, discomfort, severe pain during bowel movement, light bleeding if hemorr
hoids are large and rectal prolapse outside.
Shortness of breath, heartburn, pain and tenderness in the ribs. Escape of urine
when abdominal pressure increases. Increased need to urinate. Discomfort and pa
in in the lower abdomen. The urine may contain blood stains. Difficulty falling
asleep or waking back to sleep at night. Nasal tamponade, sudden bleeding, stuff
y or runny nose on waking. Groin pain and thighs, worse if you walk or exercise.
Sting in the back of the legs to the feet. Feeling of nausea at the sight or sm
ell certain foods or snuff smoke. It is sometimes accompanied by vomiting.
3.1.2 Common Ailments
COMPLAINTS Heartburn (Third quarter) Alteration of Taste (First, second and thir
d quarters) Cravings (First, second and third trimesters) Cramps (Third quarter)
Candidiasis (first, second and third quarters) Fatigue (First, second and third
 trimesters) Frequent urination (First, second and third quarters) Pigmentation
(Second and third quarters) Rash (Third quarter) Bleeding gums (First, second an
d third quarters) CAUSES valve pit of stomach during pregnancy relaxes, allowing
passage of small amounts of acid into the esophagus (the tube leading from the
mouth to the stomach). It is believed that hormones associated with pregnancy. A
re thought to be related to the high level of progesterone. It is thought to be
due to low blood calcium. In rare cases are caused by lack of salt in the diet.
The yeast Candida albicans infects the vagina. It is unknown why it is more comm
on during pregnancy. It can infect the mouth of the baby during birth. Sometimes
it is the concern, lack of sleep (see Insomnia), poor nutrition and towards the
end of pregnancy, the body must support the weight and the baby. Hormonal chang
es cause changes in muscle tone affecting the bladder. In addition, the uterus e
xerts pressure, forcing the evacuation of more often. Towards the end, the weigh
t of the uterus limits the ability of the bladder. Increased production of melan
ocyte-stimulating hormone. Worsens with sunlight exposure. Excessive weight gain
, poor hygiene and sweat accumulated in the folds of the skin. The gums swell an
d soften due to the effect of the hormones of pregnancy and the increased volume
of circulating blood. Swell, especially on the tooth margins, and tend to resul
t in accumulation of debris at the base of the teeth, facilitating the spread of
cavity-causing bacteria and possible infection of the gums (gingivitis). The in
creased blood supply to the vagina and cervix softening and thickening of the mu
cous membranes.€Yellow or brown may indicate cervical erosion (ulceration of th
e vagina near the cervix). During intercourse can irritate the ulcer, causing bl
ood spots are not continuous. A foul-smelling discharge may indicate a sexually
transmitted disease. Increased blood volume causes dilation of blood vessels und
er the skin. Fluid retention. If you feel different contact lenses is because th
e shape of the eyeball is altered slightly due to fluid accumulation.
Vaginal Discharge (First, second and third trimesters)
Transpiration (First, second and third quarters) Visual disorders
COMPLAINTS Varices (First, second and third trimesters)
Itching (First, second and third trimesters)
Cause will likely if family history. The baby's head puts pressure on the pelvic
veins and blood accumulates in the veins of the legs. Much worse if it stays st
anding, if you sit with crossed legs and tight, if you are overweight. They may
develop varicose veins in the vulva, which is congested and inflamed. It is a co
mmon complaint caused by increased blood flow to the skin. If it becomes severe
or pervasive, particularly in late pregnancy may signal a potentially dangerous
liver disorder, obstetric cholestasis. The accumulation of blood in the legs and
feet to be, along with the need to receive blood from the womb of the brain are
relatively private display of movement. Compression prevents the diaphragm to i
nhale and exhale freely. In the horizontal position, the uterus and the baby pus
hing the diaphragm. Occurs during pregnancy round ligament pain when stretching
the ligaments that support the uterus. Progesterone causes the softening and str
etching of the ligaments especially the joints of the pelvis. Also relax the lig
aments that support the spine, thereby increasing the burden placed muscles and
joints, lumbar, pelvic and coxal. Poor posture can worsen pain. Flank pain is ca
used by compression of the ribs when the uterus rises, the high position of the
baby's head and over-retraction. Increased liquid retained by the body, sits in
the lower parts and fingers. Pressure from the uterus on the vessels that carry
blood from the lower body to the heart. It may be associated with preeclampsia.
Progesterone causes relaxation of intestinal muscles, diminishing peristalsis. T
he contents of the intestines tends to stagnate and dry deposition difficult. De
pends on skin and its elasticity, but whatever your skin type, excessive weight
can cause stretch marks. Air that is swallowed unconsciously and gases produced
by certain foods such as vegetables, fries and onion. During pregnancy, the inte
stines become sluggish and more difficult to pass gas. The pressure of the baby'
s head on the pelvis to the end of pregnancy can clog the blood vessels of the r
ectum, preventing the return of blood from the organs of the pelvis and cause in
flammation of the veins of the rectum. Any factor that increases the pressure in
side the abdomen, constipation, chronic cough, effort, lifting heavy objects, he
morrhoids worse.
Fainting (First, second and third trimester) Shortness of breath (Third quarter)
Abdominal pain (second and third quarters) Back Pain (First, second and third t
rimesters)
Pain in the ribs (Third quarter) Edema (Third quarter)
Constipation (first, second and third quarters) Streaks (Second and third quarte
rs) Flatulence (first and third quarters) Hemorrhoids (second and third trimeste
rs)
COMPLAINTS discomfort in Bed (Third quarter) Incontinence (Third quarter) urinar
y tract infection - cystitis (first, second and third trimesters) Insomnia (Firs
t, second and third trimesters)
CAUSES It is consequence of heartburn or indigestion, or that, when lying, uteru
s compresses the diaphragm, stomach and rib cage. Pressure from the uterus on th
e bladder, which limits their ability and disables the muscles of the pelvic flo
or to stop the passage of fluid when you cough, laugh or stooping. The loosening
and relaxation of the muscular wall of the bladder predisposes to infection at
any time during pregnancy. The cause is the high level of progesterone. Symptoms
may appear gradually over several weeks or months. General increase in metaboli
sm. The metabolism of the fetus can distinguish between day and night, so you ca
n feel kicks at night.€You can also stay awake because of perspiration and urin
ation frequency. Softening and thickening of the mucous membranes. Increased cir
culation in the nasal lining due to pregnancy hormones. You will wake up with st
uffy nose. Hard blow can cause rupture of capillaries. The baby's head compresse
s the nerves causing groin pain, especially when it's embedded in the pelvic cav
ity at the end of gestation. Sudden increase of hormone levels, especially of hu
man chorionic gonadotropin (HCG). However, it is unclear why it affects some wom
en and not others. The diet before conception may predispose to nausea during pr
egnancy, especially if it is a diet low in vitamins, minerals and carbohydrates.
Fatigue worsens nausea.
Nasal discomfort (First, second and third trimesters)
Pelvic discomfort (Third quarter) morning sickness (First quarter)
3.1.3 Recommendations to discomfort in pregnancy (first quarter)
Nausea and vomiting discomfort RECOMMENDATIONS Avoid strong odors Eat crackers M
ake meals six times and small quantity. Avoid fatty foods Eat dry foods with liq
uids between meals when you need Pee Increase fluid intake during the day only i
n the afternoon decrease. The bra cup should cover the entire breast. Try to kee
p the support as most of the time. Cleaning the bathroom daily Avoid douching Ch
oose cotton underwear
Hypersensitivity Frequent urination Increased breast vaginal secretions
The capitalist Discomfort
Mouthwashes RECOMMENDATIONS astringent gum or eating hard candy (prefer the suga
r-free)
3.2 Fetal Development Milestones
LUNAR MONTH (28 DAYS) 1 0.75 to 1 mg cm 400 SIZE (LENGTH AND WEIGHT) MILESTONES
OF DEVELOPMENT The trophoblast invades the decidua basalis. Chorionic villi are
formed. Early nervous system, genitourinary system, skin, bone, lungs, eyes and
nose shape. Sketches training arms and legs The fetus is tilted. The developing
brain is responsible for the enlarged shape of the head. Sexual differentiation
begins. The centers of the bones begin to ossify.
2
2.5 cm 20 g
3
We differentiate between the fingers and toes of the fetus. Placenta and fetal m
ovement is complete. 6-9 cm 45 g
4
12 cm 110 g
Sex is differentiated. Rudimentary kidneys produce urine The presence of fetal h
eart rate. Close palate and nasal septum.
5
The lanugo covers the fetal body. Fetal movements may be perceived by the mother
. You can listen to the heartbeat. 19 cm 300 g
FETAL DEVELOPMENT MILESTONES
LUNAR MONTH (28 DAYS) 6 23 cm 630 g size (length and weight) DEVELOPMENTAL MILES
TONES fetal skin appears wrinkled and vernix caseosa. They develop eyebrows and
nails.
7
The fetal skin is red. Disappears from the eyes pupillary membrane. The normal f
etus has an excellent chance of survival. 1100 g 27 cm
8
28 to 30 cm 1800 g
The fetus is viable. Eyelids open. Fingerprints are formed. Fetal movements are
strong.
September 1932 2500 g cm
Fetal face and bodies are wrinkled appearance as a result of the deposition of s
ubcutaneous fat. Lanugo disappears. Amniotic fluid decreases.
October 1936 cm 3000-3600 g
The skin is smooth. The slate-colored eyes. The skull bones are ossified and alm
ost together at the sutures.
Note: All measurements are approximate and vary according to the standard values
used by
professionals and health institutions. The graphics are courtesy of Reeder S.J.
Martin L.I., Koniak D. Mternitity Nursing. 17va Edición. Philadelphia, J.B. Lip
pincott, 1992)
3.3 Sex During Pregnancy 2
Sex during pregnancy is one of the elements of concern in many couples from the
moment you confirm the arrival of a son, fearful that their practice can be detr
imental to the health of the mother or baby. It is an issue to be addressed open
ly with the gynecologist who controls the pregnancy, the signs will bring more c
onvenient. Is it safe sex during pregnancy? Flatly, no. Sex during pregnancy pos
es no threat to the mother or baby. Only in cases of pregnancy risk, with high c
hances of abortion would be discouraged the practice of sex partners. Keep in mi
nd that occur during orgasm contractions of the uterus and semen contains prosta
glandins, which also causes uterine contractions and even in situations of norma
l pregnancy does not pose any danger, may have adverse reactions to cases of hig
h risk pregnancy abortion.€In situations of bleeding in pregnant women would al
so be discouraged sexual practice. In any case, the gynecologist who must determ
ine the suitability of sex without pregnancy. A time of hormonal changes Simulta
neously with the considerations on the possible dangers of sex during pregnancy
raises the concern many pregnant women about the influence of pregnancy on their
sexual desire. Pregnancy causes hormonal radical change in the body of the woma
n who, of course, affect your sex drive. Could not standard behavior, because ev
ery pregnancy is a world, but in general we can determine that approximately 40%
of pregnant women experience decreased sexual desire, 50%, also approximate, re
mains unchanged and 10 outstanding % experience an increase in sexual desire. 40
% of pregnant women experience decreased sexual desire, 50%, also approximate ou
tstanding remains unchanged and 10% experience an increase in sexual desire phys
ical changes A time of sexual desire also varies in different physical causes st
ages of pregnancy and, equally unpretentious setting high standards, we can esti
mate that in the first quarter is reduced, increases in the second and also decr
eases in the last third of pregnancy. In the first few weeks there is some fear
of harming the baby, which retracts the sexual practice, in the central period o
f pregnancy produces a vascular congestion resulting in the arrival of as many
2
Article extracted http://mujer.terra.es/muj/articulo/html/mu210023.htm (See 12/1
2/1908)
blood to the pelvic blood vessels and has been observed that increases sexual de
sire, especially in women who have given birth to one or more children in late p
regnancy and the inconvenience of the volume of the fetus, muscle aches, fatigue
, difficulty breathing well or the constant movements of the baby, also causing
a shift away from sex. A time of change psychological well as hormonal and physi
cal issues, there is considerable variation in the psychological connotations of
sexual desire during pregnancy. There are women who feel unattractive, deformed
and undergo a reversal of sexual desire while others, on the contrary, it is du
ring pregnancy when they feel more attractive and desirable. Wear comfortable se
xual relations, such as physical practice, can affect pregnancy. At no time pres
sure pregnant women must suffer pain or discomfort during sex practices. Delicac
y and dialogue are the key issues to resolve this issue. The couple must communi
cate openly to agree on how to have pleasurable sex. The recommended positions f
or sex without harm to the pregnant woman or baby are as follows: â ¢ â ¢ â ¢ The man
behind the woman both lying on its side with the back of the woman attached to t
he breast of man The woman sitting on man
The following image shows an illustration with recommended positions: