Chapter 26: Pregnant Woman

Pregnant Woman details how hormonal shifts, primarily driven by estrogen and progesterone, influence every organ system, resulting in increased metabolic demands, a hypercoagulable state, and significant respiratory and gastrointestinal adjustments. The text explains visible diagnostic markers such as the Chadwick sign, melasma, and striae gravidarum, alongside internal changes like the softening of the cervical isthmus known as the Hegar sign. A significant portion of the material is dedicated to the initial prenatal visit, emphasizing accurate gestational dating using the Naegele rule and the systematic recording of obstetric history through the GP-TPAL nomenclature. Clinical techniques are prioritized, including the measurement of fundal height to track fetal growth and the use of the four Leopold maneuvers to determine fetal position and engagement within the pelvis. The chapter also underscores the importance of monitoring vital signs, specifically blood pressure, to screen for hypertensive disorders like preeclampsia and gestational hypertension. Furthermore, it outlines essential health promotion strategies, including nutritional counseling to avoid listeriosis and high-mercury fish, weight gain goals tailored to pre-pregnancy body mass index, and universal screening for intimate partner violence and perinatal depression. Laboratory protocols are also covered, ranging from Rh factor compatibility and glucose tolerance testing for gestational diabetes to screenings for infectious diseases such as syphilis, HIV, and hepatitis B. By integrating physical examination skills with empathetic history taking, this guide prepares clinicians to optimize maternal and fetal outcomes throughout the gestational cycle.