Pregnancy (or gestation) is the development of [one or more] embryo (first 8 weeks following fertilization) and later fetus (9th week afer fertilzation) in a woman's uterus. Gest is shorthand for Gestation. Gravid means pregnant.

Pregnancy is divided into 3 trimesters [of 3 months, or 12 weeks each]. This includes:

• Trimester 1 (week 1-12): carries the highest risk of miscarriage
• Trimester 2 (week 13-27): can be easier to monitor and diagnose. The point of fetal viability (i.e. fetus can survive outside the uterus) coincides with the late 2nd or early 3rd trimester [although birth constitutes high risk for having medical conditions and dying]
• Trimester 3 (week 28-birth): marked by further growth of the fetus and development of fetal fat stores

Sx typically appear within the first few weeks after conception

• Missed menstrual period
• Nausea and vomiting
• Excessive tiredness and fatigue
• Carvings for certain foods that aren't normally sought out
• Frequent urination, particularly during the night

• Embryogenesis is the development of the embryo. Once a sperm fertilizes an egg, a zygote cell results, posessing half the DNA of its 2 parents
• Amniotic fluid is the protective liquid contained by the amniotic sac, helping to cushion against blows to the mother's abdomen, for fetal movement, and promoting musculoskeletal development. The fluid originates from the maternal plasma through fetal membranes. Although amniotic fluid is originally mainly water with electrolytes, by 12-14th week, also contains proteins, carbohydrates, lipid, phospholipids, and urea, which all aid the growth of the fetus. The volume of amniotic fluid is correlated with the growth of the fetus. The volume slightly decreases when the fetus begins to breathe and swallow, and plateaus at 28 weeks gestation. The fetus inhales and exhales amniotic fluid, which also creates urine and forms meconium (i.e. pre-stool). Water breaking is when the amnion ruptures

• Sx
• Pregnancy test
• Test of progesterone levels can also help determine how likely a fetus will survive in a threatened miscarriage (i.e. bleeding in early pregnancy)
• Obstetric U/S, can detect:
  • See gestational sac, as early as 4.5 weeks gestation, and the yolk sac about 5 weeks gestation. Embryo can be observed and measured by 5.5 weeks. Heartbeat can be seen as early as 6 weeks, and usually visible by 7 weeks gestation
  • Some congenital diseases at an early stage
  • Estimate the due date
  • Detect multiple pregnancy

• Maternal:
  • Rh negative status → check BGA, and do anti D at 28 and 34 weeks
  • GBS positive status
  • Advanced maternal age → screen for birth defects
  • Maternal alcohol
  • Maternal smoking → counselling
  • Maternal obesity
  • Maternal hypertension
  • Maternal proteinuria/pre-eclampsia → regular BP, urinalysis
  • Poor maternal nutrition
  • Non-immune to rubella → postnatal MMR
  • Maternal exposure to chickenpox
  • Hepatitis B infection
  • Hepatitis C infection → do hep C RNA/LFT's, avoid invasive procedures
  • HIV/AIDS infection
  • Maternal diabetes
  • Iron deficiency anemia
  • Vaginal bleeding (threatened miscarriage, APH)
  • Maternal depression
  • Toxins, including tobacco smoke, mercury, lead, dioxin, air pollution, pesticides
  • Drugs (see pregnancy category)
  • PMH of:
    • Multiparity
    • Low birth weight
    • C section → consider VBAC, but note risk of uterine rupture
    • Postnatal depression
    • PPH
  • FH of:
    • Diabetes
• Fetal:
  • LGA, per fundal height
  • SGA, per fundal height → serial growth scans, to monitor growth

• Maternal:
  • Perineal tearing
  • Hyperemesis gravidarum
  • Pelvic girdle pain
  • HTN
  • DVT
  • Anemia
  • Infection
  • Incontinence
  • Postpartum depression
  • PTSD
• Fetal:
  • Ectopic pregnancy
  • Placental abruption
  • Multiple pregnancies
  • Vertically transmitted infection

• Pregnancies in teenagers are at greater risk of poor outcomes

• The prevalence of denial of pregnancy (i.e. refusal to acknolwedge pregnancy) is 1 in 475 women at 20 weeks, and 1 in 2500 women at delivery. In contrast, women can also have false pregnancy (i.e. non-pregnant women with strong belief they are pregnant with some physical changes)

• Menstruation
• Childbirth
• Gravidity and parity (medical notation)
• Water breaking
• Preterm birth
• Pregnancy test
• Maternal death
• Pregnancy category (drugs)
• Gestational age