Pregnancy & Different Stages

Dr.Md. Monsur Rahman, PT
BPT (GB), MPT - Musculoskelital Disorders (India), ABC Spine-Ostiopathic Approach (India), CME- Parkinson Disease (India).
Consultant- Rahela Memorial Hospital .

1. Pregnancy & Different Stages Dr. Md. Monsur Rahman,PT BPT (GB), MPT-Musculoskeletal Disorders (India), ABC Spine – Osteopathic Approach (India), CME- Parkinson Disease (India).

2. Pregnancy Pregnancy  is the development of one or more offspring , known as an  embryo   or fetus, in a woman's  uterus. It is the common name for   gestation  in  humans. Embryo & Fetus An embryo is the developing offspring during the first 8 weeks following conception. Subsequently the term  fetus  is used until birth.

3. Fig.1- First trimester (week 1-week 12 ) Fig.2- Second trimester (13- 28 week) Fig.3-Third trimester (week 29-week 40) Stages of pregnancy

4. First trimester (week 1-week 12) During the first trimester body undergoes many changes. Hormonal changes affect almost every organ system in the body. These changes can trigger symptoms even in the very first weeks of pregnancy. period stopping is a clear sign of pregnancy. Changes may include: Extreme tiredness Tender, swollen breasts. Upset stomach Mood swings Constipation (trouble having bowel movements) Need to pass urine more often Headache Heartburn Weight gain or loss

5. Second trimester (week 13-week 28) There may noticed the symptoms like nausea and fatigue are going away. But other new, more noticeable changes to the body are now happening. Abdomen will expand as the baby continues to grow. Changes are: Stretch marks on the abdomen, breasts, thighs, or buttocks Darkening of the skin around the nipples A line on the skin running from belly button to pubic hairline Numb or tingling hands

6. Third trimester (week 29-week 40) Many women find breathing difficult and notice they have to go to the bathroom even more often. This is because the baby is getting bigger and it is putting more pressure on the organs. Changes are: Shortness of breath Heartburn Swelling of the ankles, fingers, and face . Tender breasts Trouble sleeping The baby "dropping", or moving lower in your abdomen Contractions

7. Pelvic Inlet The line between the narrowest bony points formed by the  Sacral promontory  and the inner  pubic arch  is termed obstetrical conjugate : It should be 11.5 cm or more. This anteroposterior line at the inlet is 2 cm less than the  diagonal conjugate (distance from undersurface of  pubic arch  to sacral promontory). The transverse diameter of the pelvic inlet measures 13.5 cm.

8. Pelvic Outlet The lower circumference of the  lesser pelvic  is very irregular; the space enclosed by it is named the inferior aperture or pelvic outlet It has the following boundaries: Anteriorly : the  pubic arch Laterally : the ischial tuberosities Posterolaterally : the inferior margin of the sacrotuberous ligament Posteriorly : the tip of the  coccyx

9. Pelvic types Gynecoid : Ideal shape, with round to slightly oval inlet best chances for normal vaginal delivery. It has an almost round brim and will permit the passage of an average-sized baby with the least amount of trauma to the mother and baby in normal circumstances. The pelvic cavity is usually shallow, with straight side walls and with the ischial spines not so prominent as to cause a problem as the baby moves through . Android triangular inlet, and prominent ischial spines, more angulated pubic arch. It has a heart-shaped brim and is quite narrow in front. The pelvic cavity and outlet is often narrow, straight and long. The ischial spines are prominent. Women with this shape pelvis may have babies that lie with their backs against their mothers’ backs and may experience longer labours. It is important that these women take an active role during their labour and need to squat and move around as much as possible

10. Anthropoid T he widest transverse diameter is less than the anteroposterior diameter . It has an oval brim and a slightly narrow pelvic cavity. The outlet is large, although some of the other diameters may be reduced. If the baby engages in the pelvis in an anterior position, labour would be expected to be straightforward in most cases . Platypelloid Flat inlet with shortened obstetrical diameter. It has a kidney-shaped brim and the pelvic cavity is usually shallow and may be narrow in the anterior-posterior (front to back) diameter. The outlet is usually roomy. During labour the baby may have difficulty entering the pelvis, but once in, there should be no further difficulty

11. Fetal Relationship Engagement : The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet. Station : Relationship of the bony presenting part of the fetus to the maternal ischial spines. If at the level of the spines it is at “0 (zero)” station, if it passed it by 2cm it is at “+2” station. Attitude : Relationship of fetal head to spine: flexed, neutral (“military”), or extended attitudes are possible. Position : Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior.

12. Cont… Presentation : Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation. Lie : Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse. Caput   or Caput succedaneum: Oedema typically formed by the tissue overlying the fetal skull during the vaginal birthing process. Cephalo-pelvic disproportion  exists when the capacity of the pelvis is inadequate to allow the fetus to negotiate the birth canal.

13. Pelvic Floor The  pelvic floor  or  pelvic diaphragm  is composed of muscle fibers of the  levator ani , the  coccygeus , and associated  connective tissue  which span the area underneath the  pelvis . The pelvic floor consists of three muscle layers: Superficial perineal layer: innervated by the pudendal nerve Bulbocavernosus Ischiocavernosus Superficial transverse perineal External anal sphincter (EAS)

14. Pelvic Floor Cont.. Deep urogenital diaphragm layer: innervated by pudendal nerve Compressor urethera Uretrovaginal sphincter Deep transverse perineal Pelvic diaphragm: innervated by sacral nerve roots S3-S5 Levator ani: pubococcygeus ( pubovaginalis , puborectalis ), iliococcygeus Coccygeus / ischiococcygeus Piriformis Obturator internus

15. Functions of the pelvic floor It is important in providing support for pelvic viscera   e.g . the  bladder, intestines the uterus(in females ) It maintenance of continence  as part of the  urinary   and anal sphincters. It facilitates birth by resisting the descent of the presenting part, causing the fetus to rotate forwards to navigate through the pelvic girdle . It helps maintain optimal intra-abdominal pressure.

16. Clinical significance In women, the levator muscles or their supplying nerves can be damaged in pregnancy or childbirth. In female high-level athletes, perineal trauma is rare and is associated with certain sports. Damage to the pelvic floor not only contributes to urinary incontinence but can lead to pelvic organ prolapse. Pelvic organ prolapse occurs in women when pelvic organs (e.g. the vagina, bladder, rectum, or uterus) protrude into or outside of the vagina. The causes of pelvic organ prolapse are not unlike those that also contribute to urinary incontinence. These include inappropriate (asymmetrical, excessive, insufficient) muscle tone and asymmetries caused by trauma to the pelvis. Age, pregnancy, family history, and hormonal status all contribute to the development of pelvic organ prolapse. Disorders of the posterior pelvic floor include rectal prolapse perineal hernia   , and a number of functional disorders including   anismus. C onstipation  due to any of these disorders is called "functional constipation" and is identifiable by clinical diagnostic criteria .

17. At four weeks: Baby's brain and spinal cord have begun to form. The heart begins to form. Arm and leg buds appear. Your baby is now an embryo and one-twenty-fifth inch long. Changes of the baby

18. At eight weeks: All major organs and external body structures have begun to form. Baby's heart beats with a regular rhythm. The arms and legs grow longer, and fingers and toes have begun to form. The sex organs begin to form. The eyes have moved forward on the face and eyelids have formed. The umbilical cord  is clearly visible. At the end of eight weeks, baby is a fetus and looks more like a human. Your baby is nearly 1 inch long and weighs less than one-eighth ounce.

19. At 12 weeks: The nerves and muscles begin to work together. The external sex organs show if the baby is a boy or girl. Eyelids close to protect the developing eyes. They will not open again until the 28th week. Head growth has slowed, and baby is much longer. Now, at about 3 inches long, and weight is about 1 pound

20. At 16 weeks: Muscle tissue and bone continue to form, creating a more complete skeleton. Skin begins to form. Develops in the baby's intestinal tract. This will be the baby's first bowel movement. sucking reflex initiated. The baby's length is about 4 to 5 inches and weighs almost 3 ounces .

21. At 24 weeks: Bone marrow begins to make blood cells. Taste buds form on the baby's tongue. Footprints and fingerprints have formed. Real hair begins to grow on the baby's head. The lungs are formed, but do not work. The hand and startle reflex develop. Your baby sleeps and wakes regularly. The baby stores fat and has gained quite a bit of weight. Now at about 12 inches long, your baby weighs about 1½ pounds.

22. At 32 weeks: The baby's bones are fully formed, but still soft. The baby's kicks and jabs are forceful. The eyes can open and close and sense changes in light. Baby's body begins to store vital minerals, such as iron and calcium. The baby's length is about 17-18 inch and weight is about 4 pounds

23. At 36 weeks: The protective waxy coating called vernix gets thicker. Body fat increases. Your baby is getting bigger and bigger and has less space to move around. Movements are less forceful, but you will feel stretches and wiggles. Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.

24. Weeks 37-40: By the end of 37 weeks, your baby is considered full term. Your baby's organs are ready to function on their own. As you near your due date, your baby may turn into a head-down position for birth. Most babies "present" head down. At birth, your baby may weigh somewhere between 6 pounds 2 ounces and 9 pounds 2 ounces and be 19 to 21 inches long. Most full-term babies fall within these ranges. But healthy babies come in many different sizes.