Introduction to Pregnancy & Childbirth
Module 1 of 7Welcome to the Pregnancy and Childbirth Learning Platform! This interactive environment will help you master essential obstetric concepts through engaging visualizations, games, quizzes, and interactive exercises.
We'll cover everything from conception basics to labor and delivery, with special focus on terminology, fetal development, prenatal care, and the signs of pregnancy.
How to Use This Platform
Navigate through different modules using the navigation menu at the top. Each module contains interactive elements to help reinforce your learning. Complete activities to increase your progress bar and track your learning journey.
- Understand the timeline and trimesters of pregnancy
- Master pregnancy dating using Naegele's Rule
- Learn obstetric terminology (GTPAL system)
- Identify the presumptive, probable, and positive signs of pregnancy
- Follow fetal development through all stages
- Understand the stages and processes of labor and birth
- Interactive pregnancy timeline
- Due date calculator
- Fetal development visualization
- Pregnancy signs matching game
- Labor stages interactive walkthrough
- GTPAL system practice
- Knowledge check quizzes
Conception & Pregnancy Dating
Module 2 of 7Understanding how pregnancy begins and how to calculate important dates is fundamental in obstetric care. In this module, you'll learn about conception, the menstrual cycle, pregnancy timeline, and how to calculate due dates.
A typical menstrual cycle is 28 days long, with ovulation occurring around day 14. During ovulation, an egg is released from the ovary and is available for fertilization for about 24 hours.
If sperm fertilizes the egg in the fallopian tube, the fertilized egg (zygote) begins dividing and travels to the uterus. Around 6-10 days after fertilization, the developing blastocyst implants in the uterine lining, beginning pregnancy.
Pregnancy Timeline Visualization
Conception
Fertilization of egg by sperm, typically occurs around day 14 of the menstrual cycle.
End of 1st Trimester
Week 13 marks the end of the first trimester. Major organs have formed, and risk of miscarriage decreases.
End of 2nd Trimester
Week 28 marks the end of the second trimester. The baby has developed significantly and could potentially survive outside the womb.
Full Term/Delivery
Week 40 is considered full term. Most babies are born between weeks 37 and 42.
First Trimester
Conception to 13 weeks
- Embryonic development
- All major organs form
- High risk from teratogens
- Morning sickness common
Second Trimester
13 to 28 weeks
- Mother starts to "show"
- Quickening felt (16-20 weeks)
- Gender can be determined
- Often called the "golden period"
Third Trimester
28 weeks until delivery
- Rapid weight gain
- Lung maturation
- Fetal positioning
- Preparation for birth
Due Date Calculator (Naegele's Rule)
Naegele's Rule:
- Start with the first day of the Last Menstrual Period (LMP)
- Subtract 3 months
- Add 7 days
- Adjust the year:
- If LMP month is January, February, or March → Add 1 year
- If LMP month is April through December → Keep the year the same
Knowledge Check
1. When does ovulation typically occur in a 28-day menstrual cycle?
2. How long does the first trimester last?
3. Using Naegele's Rule, if a woman's LMP was May 10, 2023, what is her estimated due date?
Obstetric Terminology
Module 3 of 7Medical professionals use specific terminology to describe pregnancy history and status. In this module, you'll learn about the GTPAL system and other important obstetric terms.
G (Gravida) = Total pregnancies (including current and losses)
P (Para) = Total deliveries (even twins/triplets count as para=1)
For example, a woman who is currently pregnant for the third time, and has previously delivered one set of twins, would be described as G3P1.
- G: Gestations - Total pregnancies
- T: Term Deliveries - Births at ≥37 weeks
- P: Preterm Deliveries - Births at <37 weeks
- A: Abortions - Losses before 20 weeks (includes miscarriages and terminated pregnancies)
- L: Living Children - Current number of living children
For example, a woman who has had 3 pregnancies, with 1 term birth, 1 preterm birth, 1 miscarriage, and 2 living children would be described as G3T1P1A1L2.
GTPAL Practice Exercise
Practice determining the correct GTPAL notation for each scenario. Drag the correct values to each category.
Scenario 1:
A 32-year-old woman is currently pregnant. She has previously had two full-term deliveries, one miscarriage at 8 weeks, and both of her previous children are alive and well.
G:
T:
P:
A:
L:
Scenario 2:
A 28-year-old woman has had four pregnancies: twins delivered at 36 weeks (both living), one term delivery (child living), and one pregnancy that ended at 12 weeks. She is not currently pregnant.
G:
T:
P:
A:
L:
Knowledge Check
1. What does the "T" in GTPAL stand for?
2. A woman who has had 2 pregnancies resulting in 1 set of twins delivered at 38 weeks and 1 miscarriage would be described as:
3. If a woman is described as G4P2, this means she:
Fetal Development
Module 4 of 7Understanding fetal development is crucial for healthcare providers. In this module, you'll explore the stages of development from conception through birth, learning about key milestones and critical periods.
Pre-embryonic Stage
First 2 weeks
- Fertilization occurs
- Zygote forms and divides
- Blastocyst develops
- Implantation in uterine wall
- Beginning of placenta formation
Embryonic Stage
Weeks 3-8
- All major organs form
- Heart begins beating (week 4)
- Brain and nervous system development
- Limb buds appear and grow
- Facial features develop
Fetal Stage
Week 9 to birth
- Growth and refinement
- Organ systems mature
- Movements become stronger
- Weight gain accelerates
- Lungs mature in late stage
Interactive Fetal Development Timeline
Week 4: Early Embryo
- Size: About 0.25 inches (6mm)
- The heart begins to beat
- Neural tube forms (future brain and spinal cord)
- Beginning of arm and leg buds
- Primitive digestive system appears
Week 8: Late Embryo
- Size: About 1 inch (2.5cm)
- All major organs have begun forming
- Facial features continue developing
- Limbs have digits (fingers and toes)
- Embryo begins small movements (not felt by mother)
- End of embryonic period
Week 12: First Trimester Fetus
- Size: About 3 inches (7.5cm)
- Sex organs are distinguishable
- Fingernails and toenails forming
- Kidneys begin to produce urine
- Fetus can make facial expressions
- End of first trimester
Week 16: Second Trimester Progression
- Size: About 6-7 inches (15-18cm)
- Facial muscles developing (can grimace)
- Quickening may begin (mother may feel movement)
- Eyes can sense light (though still closed)
- Skeleton continuing to form
- Hair pattern developing on scalp
Week 20: Mid-pregnancy
- Size: About 10 inches (25cm)
- Vernix caseosa (waxy coating) begins covering skin
- Eyebrows and eyelashes present
- Sleep-wake cycles developing
- Can hear sounds from outside the womb
- Movements definitely felt by mother
Week 24: Viability Milestone
- Size: About 12 inches (30cm)
- Considered viable (could survive outside womb with intensive care)
- Lungs developing surfactant (crucial for breathing)
- Brain growing rapidly
- Fingerprints fully formed
- Regular pattern of movement
Week 28: Third Trimester Begins
- Size: About 14-15 inches (35-38cm)
- Eyes can open and close
- Breathing movements occur
- Central nervous system can control some functions
- Some babies born at this age have high survival rate
- Beginning of brain wave activity patterns
Week 32: Continued Development
- Size: About 16-17 inches (40-43cm)
- Rapid weight gain begins
- Lungs not fully mature but developing rapidly
- Can regulate body temperature
- Most babies survive if born at this stage
- Definite sleep-wake patterns established
Week 36: Early Term
- Size: About 18-19 inches (45-48cm)
- Weight: About 5.5-6 pounds (2.5-2.7kg)
- Lung development nearly complete
- Baby typically positions head-down
- Firm grasp reflex
- Very good survival rate if born now
Week 40: Full Term
- Size: About 20 inches (50cm)
- Weight: About 7-8 pounds (3.2-3.6kg)
- Lungs fully mature
- Immune system continues developing
- Ready for life outside the womb
- Skin smooth and pink
Critical Milestones in Pregnancy
5 Weeks: Heart Tone
Heart tone can be seen/heard on Doppler ultrasound.
18-20 Weeks: Kick Count
Mother begins to feel fetal movements consistently. Kick counts may begin.
24 Weeks: Viability
Baby could potentially survive outside the womb with intensive medical care. Before this point, lungs are not developed enough for survival.
28 Weeks: High Survival Rate
Chance of reaching full term is high. Third trimester begins.
34 Weeks: Lung Maturity
Lungs are mature enough that the baby has a very good chance of surviving without respiratory support if born now.
37 Weeks: Full Term
Baby is considered full term and ready for birth.
Teratogens are substances that can harm a developing fetus. They are particularly dangerous during the embryonic period (weeks 3-8) when major organs are forming.
Teratogens to Avoid
- Alcohol (can cause Fetal Alcohol Syndrome)
- Tobacco and nicotine products
- Recreational drugs
- Certain medications (e.g., Accutane, certain antidepressants)
- Radiation (X-rays without shielding)
- Certain infections (toxoplasmosis, rubella)
- Live vaccines (MMR, Varicella)
- Environmental toxins (lead, mercury)
Safe During Pregnancy
- Most fruits and vegetables
- Prenatal vitamins
- Exercise (with healthcare provider approval)
- Certain vaccines (flu, COVID-19, TDaP)
- Most common over-the-counter medications (with provider approval)
- Well-cooked meats and pasteurized dairy
Knowledge Check
1. At what week does the embryonic period end and the fetal period begin?
2. At what gestational age is a fetus considered viable (could potentially survive outside the womb)?
3. When does lung maturity typically occur?
Signs of Pregnancy
Module 5 of 7Recognizing the signs of pregnancy is crucial for healthcare providers. In this module, you'll learn about the three categories of pregnancy signs: presumptive, probable, and positive.
Presumptive Signs
Subjective signs experienced by the woman; may suggest pregnancy but are not conclusive.
Examples: morning sickness, missed period, breast tenderness
Probable Signs
Objective signs observed by the healthcare provider; more reliable but still not diagnostic.
Examples: positive pregnancy test, cervical changes, Braxton Hicks contractions
Positive Signs
Definitive signs caused only by the presence of a fetus; diagnosed by a trained healthcare provider.
Examples: visualization of fetus via ultrasound, auscultation of fetal heart tones
Presumptive Signs of Pregnancy
Breast Tenderness
Typical Onset: 3-4 weeks
Hormonal changes cause increased sensitivity and discomfort in the breasts.
Breast Enlargement
Typical Onset: 6 weeks
Glandular development and fluid retention prepare the breasts for lactation.
Amenorrhea
Typical Onset: 4 weeks
Missed period; often the first indicator leading to a pregnancy test.
Urinary Frequency
Typical Onset: 6-12 weeks
Expanding uterus places pressure on bladder; hormones increase renal circulation.
Nausea and Vomiting
Typical Onset: 4-14 weeks
"Morning sickness," linked to rising hCG levels.
Uterine Enlargement
Typical Onset: Provider ~7+ weeks; Woman ~10-12 weeks
Uterus begins to grow and may be noticed during palpation.
Hyperpigmentation (Chloasma)
Typical Onset: 16 weeks
"Mask of pregnancy"—darkened facial skin caused by increased melanin.
Fetal Movement ("Quickening")
Typical Onset: 16-20 weeks
Early perception of fetal motion, typically described as fluttering.
Probable Signs of Pregnancy
Positive Pregnancy Test
Typical Onset: 4-12 weeks
Detects hCG hormone in urine or blood, though false positives are possible.
Cervical Changes
Typical Onset: 5-8 weeks
Goodell's Sign: Cervical softening due to increased vascularity.
Chadwick's Sign: Bluish-purple discoloration of cervix/vagina from increased blood flow.
Abdominal Enlargement
Typical Onset: ~14 weeks
Uterus becomes large enough to palpate above the pubic bone.
Braxton Hicks Contractions
Typical Onset: 16-28 weeks
Irregular uterine contractions that do not cause cervical dilation.
Hegar's Sign
Typical Onset: 6-12 weeks
Softening of the lower uterine segment felt during bimanual exam.
Ballottement
Typical Onset: 16-28 weeks
Rebound of the fetus when tapped during pelvic exam.
Positive Signs of Pregnancy
Visualization of the Fetus
Typical Onset: 4-6 weeks
Confirmed via ultrasound or other imaging (yolk sac, gestational sac, or embryo seen).
Auscultation of Fetal Heart Tones
Typical Onset: 10-12 weeks
Heard with Doppler, fetoscope, or ultrasound—distinct from maternal pulse.
Fetal Movement Palpated by HCP
Typical Onset: 20 weeks
Trained examiner can detect fetal movement by touch, confirming viability.
Pregnancy Signs Matching Game
Test your knowledge of pregnancy signs by matching each sign with its correct category. Click on cards to flip them and find matches.
Knowledge Check
1. Which of the following is a positive sign of pregnancy?
2. Which pregnancy sign typically occurs first?
3. Goodell's sign refers to:
Prenatal Care
Module 6 of 7Prenatal care is essential for ensuring a healthy pregnancy and delivery. In this module, you'll learn about the components of prenatal care, physiological changes during pregnancy, and important health considerations.
Body Metrics
- Height and weight
- Pelvic measurements
- Abdominal measurements (fundal height reaches umbilicus at 20 weeks)
Urine Sample Analysis
- Protein (sign of preeclampsia if elevated)
- Glucose (potential gestational diabetes)
- Bacteria (UTI screening)
- Blood (possible infection/trauma)
- WBCs (infection indicator)
Lab Work
- Blood Type and Rh (important if mother is Rh-negative)
- Antibody screens
- Hemoglobin and hematocrit levels
- Rubella titer
- RPR (syphilis)
- Hepatitis B screening
- HIV testing
- Gonorrhea and Chlamydia testing
- Group B Strep (later in pregnancy)
First Trimester: Physiological Changes
Amenorrhea
- Caused by progesterone and estrogen maintaining the uterine lining
- Considerations for diagnosis include age and exposure
Urinary Frequency and Urgency
- Causes include hormonal shifts, fluid volume changes, and uterine growth
- Uterine growth causes pressure on the bladder due to limited space in the true pelvis
- Recommendations: Check urine and ensure hydration
Vaginal, Vulvar, and Cervical Changes
- Increased vaginal discharge (leukorrhea)
- Color changes due to increased vascularity of pelvic organs
- Recommendations:
- Wear a pad and change it frequently
- Report any itching, odor, or other concerns
Gastrointestinal
- Nausea and vomiting triggered by increased hormones and decreased gastric motility
- Management strategies:
- Frequent "dry" meals
- Consuming crackers
- Avoiding strong odors
- Using ginger as a remedy
- Only use medications as a last resort
Musculoskeletal and Skin
- Breast and skin changes caused by hormones: estrogen, melanocyte-stimulating hormone, and progesterone
- Recommendations:
- For breast soreness: Use a supportive bra
- Apply lotion for an itching, growing abdomen
Neurological
- Fatigue and headache caused by hormonal shifts and body adjustment
- Recommendations:
- Ensure rest and relaxation
- Engage in mild exercise
- Report any severe or unrelenting fatigue
- Avoid over-the-counter medicines without healthcare provider's approval
Psychological Response During Pregnancy
First Trimester
- Uncertainty about pregnancy
- Ambivalence about becoming a parent
- Focus on self and bodily changes
- Changes in sexuality and intimacy
- May experience anxiety about miscarriage
Second Trimester
- Increased acceptance of pregnancy
- Beginning of maternal-fetal bonding
- Shifts focus from self to baby
- Often a period of emotional stability
- Preparation for parenting role begins
Third Trimester
- Anxiety about labor and delivery
- Nesting instinct may emerge
- Increased concern about parenting abilities
- Physical discomfort may affect mood
- Anticipation and excitement about meeting baby
Nutrition in Pregnancy
Dietary Recommendations
- Increased calories (about 300 extra per day)
- Increased protein intake
- Folic acid (prevents neural tube defects)
- Iron (prevents anemia)
- Calcium (for fetal bone development)
- Prenatal vitamins to supplement nutrients
- Stay well-hydrated
Foods to Avoid
- Raw or undercooked meat
- Deli meats (risk of listeria)
- High-mercury fish (shark, swordfish, king mackerel)
- Raw eggs
- Unpasteurized dairy products
- Excessive caffeine
- Alcohol
- Unwashed produce
Pica: Craving and consuming non-food items (like clay, ice, dirt). May indicate nutritional deficiency, particularly iron. Should be reported to healthcare provider.
Fetal Wellbeing Tests
Non-Stress Test (NST)
Monitors fetal heart rate in response to fetal movement. A reactive (normal) NST shows heart rate acceleration with movement.
Biophysical Profile (BPP)
Combines NST with ultrasound assessment of fetal movement, breathing, tone, and amniotic fluid volume. Scored out of 10 points.
Amniocentesis
Tests amniotic fluid for genetic abnormalities and neural tube defects. Typically done between 15-20 weeks.
Chorionic Villus Sampling (CVS)
Done between 10-13 weeks to detect Down syndrome, cystic fibrosis, and fetal gender. Sample taken from placenta rather than amniotic fluid.
Leopold's Maneuvers
Series of palpation techniques to determine fetal position, presentation, and engagement. Important for assessing readiness for vaginal delivery.
Kick Counts
Mother counts fetal movements. Generally, at least 10 movements within 2 hours is reassuring.
Prenatal Visit Schedule
| Timeline | Visit Frequency | Key Components |
|---|---|---|
| First Prenatal Visit | As soon as pregnancy confirmed |
|
| Up to 28 weeks | Every 4 weeks |
|
| 28-36 weeks | Every 2 weeks |
|
| 36 weeks to delivery | Weekly |
|
Knowledge Check
1. Which of the following is NOT typically tested in routine urine analysis during prenatal visits?
2. At what point in pregnancy does fundal height typically reach the umbilicus?
3. Which test is typically performed between 10-13 weeks of pregnancy to detect Down syndrome and cystic fibrosis?
Labor & Birth
Module 7 of 7Understanding the process of labor and birth is essential for obstetric care. In this module, you'll learn about the signs of labor, stages of labor, and factors that influence the birth process.
True Labor
- Regular contractions that increase in frequency, duration, and intensity
- Pain that starts in the back and wraps around to the abdomen
- Progressive cervical dilation and effacement
- Walking intensifies contractions
- Contractions continue despite rest or position changes
False Labor (Braxton Hicks)
- Irregular contractions with variable intensity
- Pain primarily in the abdomen
- No cervical change
- Walking may provide relief
- Contractions may subside with rest, hydration, or position change
The 5 P's of Labor
1. Passenger (Baby)
- Fetal size and weight
- Fetal position (vertex, breech, etc.)
- Fetal presentation (cephalic, face, shoulder)
- Fetal attitude (degree of flexion)
2. Passageway (Pelvis)
- Pelvic type and dimensions
- Soft tissue resistance
- Cervical effacement and dilation
- Vaginal capacity
3. Powers
- Primary: Uterine contractions
- Secondary: Maternal pushing efforts
- Strength, frequency, and duration of contractions
4. Position (Maternal)
- Maternal posture during labor
- Upright positions use gravity to aid descent
- Side-lying reduces pressure on vena cava
- Hands and knees may help with back labor
5. Psyche
- Maternal psychological state
- Fear and anxiety can impede labor progress
- Support system and environment
- Cultural factors and personal expectations
Stages of Labor
First Stage: Dilation
From: Onset of true labor
To: Complete cervical dilation (10 cm)
Typical Duration: 8-18 hours (primipara), 5-12 hours (multipara)
Phases:
- Latent Phase: 0-3 cm dilation, contractions 5-30 min apart, mild to moderate intensity
- Active Phase: 4-7 cm dilation, contractions 2-5 min apart, moderate to strong intensity
- Transition Phase: 8-10 cm dilation, contractions 1-2 min apart, very strong intensity
Nursing Care:
- Assess maternal and fetal status regularly
- Support comfort measures and positioning
- Encourage hydration and voiding
- Monitor progression of labor
Second Stage: Pushing and Birth
From: Complete cervical dilation (10 cm)
To: Birth of the baby
Typical Duration: 30 minutes - 3 hours (primipara), 5-30 minutes (multipara)
Cardinal Movements of Labor:
- Engagement: Widest part of presenting part enters pelvic inlet
- Descent: Presenting part moves downward through pelvis
- Flexion: Fetal chin tucks to chest to present smallest diameter
- Internal rotation: Fetal head rotates to align with pelvic outlet
- Extension: Fetal head extends as it passes under pubic arch
- External rotation: Fetal head rotates to align with shoulders
- Expulsion: Complete birth of baby
Nursing Care:
- Guide effective pushing techniques
- Monitor fetal status closely
- Prepare for delivery
- Assist with birth as needed
Third Stage: Placental Delivery
From: Birth of the baby
To: Delivery of the placenta
Typical Duration: 5-30 minutes
Signs of Placental Separation:
- Sudden gush of blood
- Lengthening of the umbilical cord
- Change in uterine shape (globular)
- Uterus rises in abdomen
Delivery Methods:
- Schultze Mechanism: Shiny fetal side presents first
- Duncan Mechanism: Rough maternal side presents first
Nursing Care:
- Assess for signs of placental separation
- Monitor bleeding
- Inspect placenta for completeness
- Begin postpartum care
Fourth Stage: Recovery
From: Delivery of the placenta
To: 1-2 hours postpartum
Focus: Stabilizing mother's condition
Maternal Assessment:
- Vital signs
- Fundal firmness
- Lochia (vaginal discharge) amount and character
- Perineal integrity
- Bladder status
Newborn Assessment:
- Apgar scores
- Respiratory effort
- Thermoregulation
- Initial feeding
Nursing Care:
- Monitor for postpartum hemorrhage
- Promote parent-infant bonding
- Assist with breastfeeding initiation
- Provide comfort measures
- Begin parent education
Pain Management in Labor
Pharmacologic Methods
- Epidural Anesthesia: Most common, provides pain relief from waist down
- Spinal Block: Provides rapid pain relief, often used for C-sections
- Combined Spinal-Epidural: Offers benefits of both techniques
- IV Medications: Opioids like fentanyl provide temporary relief
- Nitrous Oxide: Self-administered gas providing mild pain relief
Non-Pharmacologic Methods
- Breathing Techniques: Controlled breathing to manage pain
- Hydrotherapy: Using water (shower, tub) for pain relief
- Massage: Counter-pressure for back labor
- Position Changes: Different positions to optimize comfort
- TENS Unit: Electrical stimulation for pain management
- Heat/Cold Therapy: Applied to back or perineum
- Acupressure/Acupuncture: Traditional methods for pain relief
- Hypnobirthing: Using relaxation and visualization techniques
Fetal Monitoring
Monitoring Methods
- External:
- Ultrasound for fetal heart rate
- Tocodynamometer for contractions
- Non-invasive but less accurate
- Internal:
- Fetal scalp electrode for heart rate
- Intrauterine pressure catheter for contractions
- More accurate but invasive (requires ruptured membranes)
- Intermittent Auscultation:
- Using Doppler or fetoscope at intervals
- Common in low-risk births
- Allows more mobility for mother
Fetal Heart Rate Patterns
- Reassuring Patterns:
- Baseline: 110-160 bpm
- Moderate variability
- Accelerations with movement
- No decelerations or early decelerations only
- Non-Reassuring Patterns:
- Tachycardia (>160 bpm) or bradycardia (<110 bpm)
- Minimal or absent variability
- Late decelerations (indicate uteroplacental insufficiency)
- Variable decelerations (indicate cord compression)
- Prolonged decelerations (>2 minutes)
- Interventions for Non-Reassuring Patterns:
- Maternal position change
- Oxygen administration
- IV fluid bolus
- Discontinue oxytocin if in use
- Prepare for expedited delivery if no improvement
Knowledge Check
1. Which of the following is a characteristic of true labor?
2. Which stage of labor is characterized by the delivery of the placenta?
3. Which of the following is a non-reassuring fetal heart rate pattern?