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Pregnancy is the time during which one or more offspring develops (gestates) inside a woman's uterus (womb).[4][13] A multiple pregnancy involves more than one offspring, such as with twins.[14]

Pregnancy usually occurs by sexual intercourse, but can also occur through assisted reproductive technology procedures.[6] A pregnancy may end in a live birth, a miscarriage, an induced abortion, or a stillbirth. Childbirth typically occurs around 40 weeks from the start of the last menstrual period (LMP), a span known as the gestational age.[4][5] This is just over nine months. Counting by fertilization age, the length is about 38 weeks.[5][13] Pregnancy is "the presence of an implanted human embryo or fetus in the uterus"; implantation occurs on average 8–9 days after fertilization.[15] An embryo is the term for the developing offspring during the first seven weeks following implantation (i.e. ten weeks' gestational age), after which the term fetus is used until birth.[5]

Signs and symptoms of early pregnancy may include missed periods, tender breasts, morning sickness (nausea and vomiting), hunger, implantation bleeding, and frequent urination.[1] Pregnancy may be confirmed with a pregnancy test.[7] Methods of birth control—or, more accurately, contraception—are used to avoid pregnancy.

Pregnancy is divided into three trimesters of approximately three months each. The first trimester includes conception, which is when the sperm fertilizes the egg. The fertilized egg then travels down the Fallopian tube and attaches to the inside of the uterus, where it begins to form the embryo and placenta. During the first trimester, the possibility of miscarriage (natural death of embryo or fetus) is at its highest. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can survive outside of the uterus if provided with high-quality medical care, though babies born at this time will likely experience serious health complications such as heart and respiratory problems and long-term intellectual and developmental disabilities.

Prenatal care improves pregnancy outcomes.[9] Nutrition during pregnancy is important to ensure healthy growth of the fetus.[16] Prenatal care may also include avoiding recreational drugs (including tobacco and alcohol), taking regular exercise, having blood tests, and regular physical examinations.[9] Complications of pregnancy may include disorders of high blood pressure, gestational diabet

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es, iron-deficiency anemia, and severe nausea and vomiting.[3] In the ideal childbirth, labor begins on its own "at term".[17] Babies born before 37 weeks are "preterm" and at higher risk of health problems such as cerebral palsy.[4] Babies born between weeks 37 and 39 are considered "early term" while those born between weeks 39 and 41 are considered "full term".[4] Babies born between weeks 41 and 42 weeks are considered "late-term" while after 42 weeks they are considered "post-term".[4] Delivery before 39 weeks by labor induction or caesarean section is not recommended unless required for other medical reasons.[18]

About 213 million pregnancies occurred in 2012, of which, 190 million (89%) were in the developing world and 23 million (11%) were in the developed world.[11] The number of pregnancies in women aged between 15 and 44 is 133 per 1,000 women.[11] About 10% to 15% of recognized pregnancies end in miscarriage.[2] In 2016, complications of pregnancy resulted in 230,600 maternal deaths, down from 377,000 deaths in 1990.[12] Common causes include bleeding, infections, hypertensive diseases of pregnancy, obstructed labor, miscarriage, abortion, or ectopic pregnancy.[12] Globally, 44% of pregnancies are unplanned.[19] Over half (56%) of unplanned pregnancies are aborted.[19] Among unintended pregnancies in the United States, 60% of the women used birth control to some extent during the month pregnancy began.[20]

Terminology
Title page from an 18th-century book about pregnancy
William Hunter, Anatomia uteri humani gravidi tabulis illustrata, 1774
Associated terms for pregnancy are gravid and parous. Gravidus and gravid come from the Latin word meaning "heavy" and a pregnant female is sometimes referred to as a gravida.[21] Gravidity refers to the number of times that a female has been pregnant. Similarly, the term parity is used for the number of times that a female carries a pregnancy to a viable stage.[22] Twins and other multiple births are counted as one pregnancy and birth.

A woman who has never been pregnant is referred to as a nulligravida. A woman who is (or has been only) pregnant for the first time is referred to as a primigravida,[23] and a woman in subsequent pregnancies as a multigravida or as multiparous.[21][24] Therefore, during a second pregnancy a woman would be described as gravida 2, para 1 and upon live delivery as gravida 2, para 2. In-progress pregnancies, abortions, miscarriages and/or stillbirths account for parity values b

eing less than the gravida number. Women who have never carried a pregnancy more than 20 weeks are referred to as nulliparous.[25]

A pregnancy is considered term at 37 weeks of gestation. It is preterm if less than 37 weeks and postterm at or beyond 42 weeks of gestation. American College of Obstetricians and Gynecologists have recommended further division with early term 37 weeks up to 39 weeks, full term 39 weeks up to 41 weeks, and late term 41 weeks up to 42 weeks.[26] The terms preterm and postterm have largely replaced earlier terms of premature and postmature. Preterm and postterm are defined above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.[27][28]

Signs and symptoms
Main article: Signs and symptoms of pregnancy
Further information: Complications of pregnancy

Melasma: pigment changes to the face due to pregnancy

In the later part of pregnancy the uterus takes up much of the abdomen.
The usual signs and symptoms of pregnancy do not significantly interfere with activities of daily living or pose a health-threat to the mother or baby. However, pregnancy complications can cause other more severe symptoms, such as those associated with anemia.

Common signs and symptoms of pregnancy include:

Tiredness
Morning sickness
Constipation
Pelvic girdle pain
Back pain
Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
Peripheral edema swelling of the lower limbs. Common complaint in advancing pregnancy. Can be caused by inferior vena cava syndrome resulting from compression of the inferior vena cava and pelvic veins by the uterus leading to increased hydrostatic pressure in lower extremities.
Low blood pressure often caused by compression of both the inferior vena cava and the abdominal aorta (aortocaval compression syndrome).
Increased urinary frequency. A common complaint, caused by increased intravascular volume, elevated glomerular filtration rate, and compression of the bladder by the expanding uterus.
Urinary tract infection[29]
Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.
Hemorrhoids (piles). Swollen veins at or inside the anal area. Caused by impaired venous return, straining associated with constipation, or increased intra-abdominal pressure in later pregnancy.[30]
Regurgitation, heartburn, and na

usea.
Stretch marks
Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.[31]
Melasma, also known as the mask of pregnancy, is a discoloration, most often of the face. It usually begins to fade several months after giving birth.

Timeline
Comparison of dating systems for a typical pregnancy
Event Gestational age
(from the start of the last menstrual period)

Fertilization age Implantation age
Menstrual period begins Day 1 of pregnancy Not pregnant Not pregnant
Has sex and ovulates 2 weeks pregnant Not pregnant Not pregnant
Fertilization; cleavage stage begins[32] Day 15[32] Day 1[32][33] Not pregnant
Implantation of blastocyst begins Day 20 Day 6[32][33] Day 0
Implantation finished Day 26 Day 12[32][33] Day 6 (or Day 0)
Embryo stage begins; also, first missed period 4 weeks Day 15[32] Day 9
Primitive heart function can be detected 5 weeks, 5 days[32] Day 26[32] Day 20
Fetal stage begins 10 weeks, 1 day[32] 8 weeks, 1 day[32] 7 weeks, 2 days
First trimester ends 13 weeks 11 weeks 10 weeks
Second trimester ends 26 weeks 24 weeks 23 weeks
Childbirth 39–40 weeks 37–38 weeks[33]: 108  36–37 weeks

The chronology of pregnancy is, unless otherwise specified, generally given as gestational age, where the starting point is the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. This model means that the woman is counted as being "pregnant" two weeks before conception and three weeks before implantation. Sometimes, timing may also use the fertilization age, which is the age of the embryo since conception.

Start of gestational age
Main article: Gestational age
The American Congress of Obstetricians and Gynecologists recommend the following methods to calculate gestational age:[34]

Directly calculating the days since the beginning of the last menstrual period.
Early obstetric ultrasound, comparing the size of an embryo or fetus to that of a reference group of pregnancies of known gestational age (such as calculated from last menstrual periods), and using the mean gestational age of other embryos or fetuses of the same size. If the gestational age as calculated from an early ultrasound is contradictory to the one calculated directly from the last menstrual period, it is still the one from the early ultrasound that is used for the rest of the pregnancy.[34]
In case of in vitro fertilization, calculating days si

nce oocyte retrieval or co-incubation and adding 14 days.[35]
Trimesters
Pregnancy is divided into three trimesters, each lasting for approximately three months.[4] The exact length of each trimester can vary between sources.

The first trimester begins with the start of gestational age as described above, that is, the beginning of week 1, or 0 weeks + 0 days of gestational age (GA). It ends at week 12 (11 weeks + 6 days of GA)[4] or end of week 14 (13 weeks + 6 days of GA).[36]
The second trimester is defined as starting, between the beginning of week 13 (12 weeks +0 days of GA)[4] and beginning of week 15 (14 weeks + 0 days of GA).[36] It ends at the end of week 27 (26 weeks + 6 days of GA)[36] or end of week 28 (27 weeks + 6 days of GA).[4]
The third trimester is defined as starting, between the beginning of week 28 (27 weeks + 0 days of GA)[36] or beginning of week 29 (28 weeks + 0 days of GA).[4] It lasts until childbirth.

Timeline of pregnancy, including (from top to bottom): Trimesters, embryo/fetus development, gestational age in weeks and months, viability and maturity stages
Estimation of due date

Distribution of gestational age at childbirth among singleton live births, given both when gestational age is estimated by first trimester ultrasound and directly by last menstrual period.[37] Roughly 80% of births occur between 37 and 41 weeks of gestational age.
Main article: Estimated date of delivery
Due date estimation basically follows two steps:

Determination of which time point is to be used as origin for gestational age, as described in the section above.
Adding the estimated gestational age at childbirth to the above time point. Childbirth on average occurs at a gestational age of 280 days (40 weeks), which is therefore often used as a standard estimation for individual pregnancies.[38] However, alternative durations as well as more individualized methods have also been suggested.
The American College of Obstetricians and Gynecologists divides full term into three divisions:[39]

Early-term: 37 weeks and 0 days through 38 weeks and 6 days
Full-term: 39 weeks and 0 days through 40 weeks and 6 days
Late-term: 41 weeks and 0 days through 41 weeks and 6 days
Post-term: greater than or equal to 42 weeks and 0 days
Naegele's rule is a standard way of calculating the due date for a pregnancy when assuming a gestational age of 280 days at childbirth. The rule estimates the expected date of delivery (EDD) by adding a year, subtracting three months,

and adding seven days to the origin of gestational age. Alternatively there are mobile apps, which essentially always give consistent estimations compared to each other and correct for leap year, while pregnancy wheels made of paper can differ from each other by 7 days and generally do not correct for leap year.[40]

Furthermore, actual childbirth has only a certain probability of occurring within the limits of the estimated due date. A study of singleton live births came to the result that childbirth has a standard deviation of 14 days when gestational age is estimated by first trimester ultrasound, and 16 days when estimated directly by last menstrual period.[37]

Physiology
Capacity
Further information: Pregnancy over age 50
Fertility and fecundity are the respective capacities to fertilize and establish a clinical pregnancy and have a live birth. Infertility is an impaired ability to establish a clinical pregnancy and sterility is the permanent inability to establish a clinical pregnancy.[41]

The capacity for pregnancy depends on the reproductive system, its development and its variation, as well as on the condition of a person. Women as well as intersex and transgender people who have a functioning female reproductive system are capable of pregnancy. In some cases, someone might be able to produce fertilizable eggs, but might not have a womb or none that can sufficiently gestate, in which case they might find surrogacy.[42]

Initiation
See also: Human fertilization

Fertilization and implantation in humans.
Through an interplay of hormones that includes follicle stimulating hormone that stimulates folliculogenesis and oogenesis creates a mature egg cell, the female gamete. Fertilization is the event where the egg cell fuses with the male gamete, spermatozoon. After the point of fertilization, the fused product of the female and male gamete is referred to as a zygote or fertilized egg. The fusion of female and male gametes usually occurs following the act of sexual intercourse. Pregnancy rates for sexual intercourse are highest during the menstrual cycle time from some 5 days before until 1 to 2 days after ovulation.[43] Fertilization can also occur by assisted reproductive technology such as artificial insemination and in vitro fertilisation.

Fertilization (conception) is sometimes used as the initiation of pregnancy, with the derived age being termed fertilization age. Fertilization usually occurs about two weeks before the next expected menstrual

period.

A third point in time is also considered by some people to be the true beginning of a pregnancy: This is time of implantation, when the future fetus attaches to the lining of the uterus. This is about a week to ten days after fertilization.[44]

Development of embryo and fetus
Main articles: Human embryonic development, Prenatal development, and Fetus

The initial stages of human embryogenesis
The sperm and the egg cell, which has been released from one of the female's two ovaries, unite in one of the two Fallopian tubes. The fertilized egg, known as a zygote, then moves toward the uterus, a journey that can take up to a week to complete. Cell division begins approximately 24 to 36 hours after the female and male cells unite. Cell division continues at a rapid rate and the cells then develop into what is known as a blastocyst. The blastocyst arrives at the uterus and attaches to the uterine wall, a process known as implantation.

The development of the mass of cells that will become the infant is called embryogenesis during the first approximately ten weeks of gestation. During this time, cells begin to differentiate into the various body systems. The basic outlines of the organ, body, and nervous systems are established. By the end of the embryonic stage, the beginnings of features such as fingers, eyes, mouth, and ears become visible. Also during this time, there is development of structures important to the support of the embryo, including the placenta and umbilical cord. The placenta connects the developing embryo to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. The umbilical cord is the connecting cord from the embryo or fetus to the placenta.

After about ten weeks of gestational age—which is the same as eight weeks after conception—the embryo becomes known as a fetus.[45] At the beginning of the fetal stage, the risk of miscarriage decreases sharply.[46] At this stage, a fetus is about 30 mm (1.2 inches) in length, the heartbeat is seen via ultrasound, and the fetus makes involuntary motions.[47] During continued fetal development, the early body systems, and structures that were established in the embryonic stage continue to develop. Sex organs begin to appear during the third month of gestation. The fetus continues to grow in both weight and length, although the majority of the physical growth occurs in the last weeks of pregnancy.

Electrical brain activity is first detected

at the end of week 5 of gestation, but as in brain-dead patients, it is primitive neural activity rather than the beginning of conscious brain activity. Synapses do not begin to form until week 17.[48] Neural connections between the sensory cortex and thalamus develop as early as 24 weeks' gestational age, but the first evidence of their function does not occur until around 30 weeks, when minimal consciousness, dreaming, and the ability to feel pain emerges.[49]

Although the fetus begins to move during the first trimester, it is not until the second trimester that movement, known as quickening, can be felt. This typically happens in the fourth month, more specifically in the 20th to 21st week, or by the 19th week if the woman has been pregnant before. It is common for some women not to feel the fetus move until much later. During the second trimester, when the body size changes, maternity clothes may be worn.

Maternal changes

The uterus expands making up a larger and larger portion of the abdomen. During the final stages of gestation the uterus may drop to a lower position.
Main article: Maternal physiological changes in pregnancy

Breast changes as seen during pregnancy. The areolae are larger and darker.
During pregnancy, a woman undergoes many normal physiological changes, including behavioral, cardiovascular, hematologic, metabolic, renal, and respiratory changes. Increases in blood sugar, breathing, and cardiac output are all required. Levels of progesterone and estrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and therefore the menstrual cycle. A full-term pregnancy at an early age (less than 25 years) reduces the risk of breast, ovarian, and endometrial cancer, and the risk declines further with each additional full-term pregnancy.[50][51]

End of second trimester + 2 weeks (26 weeks of pregnancy)
The fetus is genetically different from its mother and can therefore be viewed as an unusually successful allograft.[52] The main reason for this success is increased immune tolerance during pregnancy,[53] which prevents the mother's body from mounting an immune system response against certain triggers.[52]

During the first trimester, minute ventilation increases by 40 percent.[54] The womb will grow to the size of a lemon by eight weeks. Many symptoms and discomforts of pregnancy, such as nausea and tender breasts, appear in the first trimester.[55]

During the second trimester, most women feel more energized and put

on weight as the symptoms of morning sickness subside. They begin to feel regular fetal movements, which can become strong and even disruptive.[citation needed]

Braxton Hicks contractions are sporadic uterine contractions that may start around six weeks into a pregnancy; however, they are usually not felt until the second or third trimester.[56]

Final weight gain takes place during the third trimester; this is the most weight gain throughout the pregnancy. The woman's abdomen will transform in shape as the fetus turns in a downward position ready for birth. The woman's navel will sometimes become convex, "popping" out, due to the expanding abdomen. The uterus, the muscular organ that holds the developing fetus, can expand up to 20 times its normal size during pregnancy.

Head engagement, also called "lightening" or "dropping", occurs as the fetal head descends into a cephalic presentation. While it relieves pressure on the upper abdomen and gives a renewed ease in breathing, it also severely reduces bladder capacity, resulting in a need to void more frequently, and increases pressure on the pelvic floor and the rectum. It is not possible to predict when lightening will occur. In a first pregnancy it may happen a few weeks before the due date, though it may happen later or even not until labor begins, as is typical with subsequent pregnancies.[57]

It is during the third trimester that maternal activity and sleep positions may affect fetal development due to restricted blood flow. For instance, the enlarged uterus may impede blood flow by compressing the vena cava when lying flat, a conditioned that can be relieved by lying on the left side.[58]

Childbirth
Main article: Childbirth
Childbirth, referred to as labor and delivery in the medical field, is the process whereby an infant is born.[59]

A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix—primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful va**nal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding. St

udies show that skin-to-skin contact between a mother and her newborn immediately after birth is beneficial for both the mother and baby. A review done by the World Health Organization found that skin-to-skin contact between mothers and babies after birth reduces crying, improves mother–infant interaction, and helps mothers to breastfeed successfully. They recommend that neonates be allowed to bond with the mother during their first two hours after birth, the period that they tend to be more alert than in the following hours of early life.[60]

Childbirth maturity stages
Further information: Preterm birth and Postterm pregnancy

In the ideal childbirth labor begins on its own when a woman is "at term".[17] Events before completion of 37 weeks are considered preterm.[61] Preterm birth is associated with a range of complications and should be avoided if possible.[63]

Sometimes if a woman's water breaks or she has contractions before 39 weeks, birth is unavoidable.[62] However, spontaneous birth after 37 weeks is considered term and is not associated with the same risks of a preterm birth.[59] Planned birth before 39 weeks by caesarean section or labor induction, although "at term", results in an increased risk of complications.[64] This is from factors including underdeveloped lungs of newborns, infection due to underdeveloped immune system, feeding problems due to underdeveloped brain, and jaundice from underdeveloped liver.[65]

Babies born between 39 and 41 weeks' gestation have better outcomes than babies born either before or after this range.[62] This special time period is called "full term".[62] Whenever possible, waiting for labor to begin on its own in this time period is best for the health of the mother and baby.[17] The decision to perform an induction must be made after weighing the risks and benefits, but is safer after 39 weeks.[17]

Events after 42 weeks are considered postterm.[62] When a pregnancy exceeds 42 weeks, the risk of complications for both the woman and the fetus increases significantly.[66][67] Therefore, in an otherwise uncomplicated pregnancy, obstetricians usually prefer to induce labour at some stage between 41 and 42 weeks.[68]

Postnatal period
Main article: Postpartum period
The postpartum period also referred to as the puerperium, is the postnatal period that begins immediately after delivery and extends for about six weeks.[59] During this period, the mother's body begins the return to pre-pregnancy conditions that inc

ludes changes in hormone levels and uterus size.[59]

Diagnosis
The beginning of pregnancy may be detected either based on symptoms by the woman herself, or by using pregnancy tests. However, an important condition with serious health implications that is quite common is the denial of pregnancy by the pregnant woman. About 1 in 475 denials will last until around the 20th week of pregnancy. The proportion of cases of denial, persisting until delivery is about 1 in 2500.[69] Conversely, some non-pregnant women have a very strong belief that they are pregnant along with some of the physical changes. This condition is known as a false pregnancy.[70]

Physical signs
Further information: Signs and symptoms of pregnancy

Most pregnant women experience a number of symptoms,[71] which can signify pregnancy. A number of early medical signs are associated with pregnancy.[72][73] These signs include:

the presence of human chorionic gonadotropin (hCG) in the blood and urine
missed menstrual period
implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period
increased basal body temperature sustained for over two weeks after ovulation
Chadwick's sign (bluish discolouration of the cervix, va**na, and vulva)
Goodell's sign (softening of the va**nal portion of the cervix)
Hegar's sign (softening of the uterine isthmus)
Pigmentation of the linea alba, called linea nigra (darkening of the skin in a midline of the abdomen, resulting from hormonal changes, usually appearing around the middle of pregnancy).[72][73]
Darkening of the nipples and areolas due to an increase in hormones.[74]
Biomarkers
Further information: Pregnancy test
Pregnancy detection can be accomplished using one or more various pregnancy tests,[75] which detect hormones generated by the newly formed placenta, serving as biomarkers of pregnancy.[76] Blood and urine tests can detect pregnancy by 11 and 14 days, respectively, after fertilization.[77][78] Blood pregnancy tests are more sensitive than urine tests (giving fewer false negatives).[79] Home pregnancy tests are urine tests, and normally detect a pregnancy 12 to 15 days after fertilization.[80] A quantitative blood test can determine approximately the date the embryo was fertilized because hCG levels double every 36 to 72 hours before 8 weeks' gestation.[59][78] A single test of progesterone levels can also help determine how likely a fetus will survive in those with a threat

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