Beruflich Dokumente
Kultur Dokumente
Definition
Careful, systematic assessment and follow up of a pregnant patient to assure the best health of the mother and her fetus.
First visit
History: Medical problems (DM, HT, others). Surgical, previous operations, complications and need for transfusion. Family hx- inherited problems (medical diseases, congenital anomalies, cystic fibrosis, hemophilia..).
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Social hx- psychosocial background and lifestyle, smoking, alcohol Obstetric- EDC, recurrent problems (fetal & neonatal death, preterm deliveries, IUGR, macrocosmic babies, anomalies, abruptio, HT, PET, GDM, PPH, thromboembolism.). Gynaecologic- infertility treatment, PID, ectopic pregnancy, STDs).
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How is GA determined?
Accurate estimation is vital & mandatory. First day of the last normal menstrual period. Regular and normal periods?
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BPD FL
3rd trimester: - Much less accurate.
AC
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Physical examination:
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Contlab tests
Hepatitis screen: - Hepatitis B-sAg: transmit to the fetus mainly during birth. - Many of those babies become carrier & can develop chronic hepatitis. - Hep B Ig & vaccine within 12 hrs of life. - ?Hepatitis C.
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Contlab tests
Serologic tests for syphilis (VDRL). - In our country not mandatory. HIV antibody (with consent). - not in our country. Blood sugar, random. ?Pap smear.
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Revisits
History: Brief history to uncover any new problems. Ask about pain, contractions, vaginal discharge, fetal movements Specific questions, those with medical problems or known complications. Counseling for those desiring sterilization.
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Contrevisits
Physical examination: Weight & blood pressure. Examine the gravid uterus. Measure fundal height (IUGR). Determine fetal lie & presentation (3rd trim). Estimate fetal weight (small vs large baby). Auscultate fetal heart tones (sunicade). Pelvic examination, if indicated.
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Conrevisits
Laboratory tests: Hematocrit/ hemaglobin, Repeat at 28 & 36 weeks, or if indicated. Urine dipstick on each revisit, Presence of significant proteinuria (PET) Presence of glucosuria (GDM). Presence of leukocytes (UTI).
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Contrevisits
Antibody screen, if Rh-negative women Repeat at 28 & 34 weeks, if negative Give Anti-D immune globulin. Glucose screen, glucose tolerance test At 26-28 weeks. Repeat at 32 weeks, in high risk patients. Screening for group B streptococcus (GPS), Low vaginal swab (LVS) at 35-37 weeks. Significant reduction of early onset GBS neonatal infection.
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3rd trimester: When indicated (high risk pregnancy), Growth & fetal welfare parameters. Regular/ serial U/S: High risk pregnancy. Poor obstetric history. New problem during ANC (IUGR, PET, GDM).
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Then,
Pregnancy is classified to be low or high risk. Scoring system for risk assessment.
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Important signs!
Vaginal bleeding. Abdominal or pelvic pain. Uterine contractions from 20-36 weeks. Leaking of fluid from vagina. Decrease in fetal movements. Severe headache or blurring of vision. Persistent vomiting. Fever. Swelling of hands or face.
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Anemia due to iron or folic acid deficiency. Urinary tract infections and pyelonephritis. Pregnancy induced hypertension & PET. Preterm labour and delivery. Intrauterine growth restriction.
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Cont
Sexually transmitted diseases. Rh isoimmunization. Fetal macrosomia. Hypoxia or fetal death from post-term birth. Breech presentation at term.
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Listeria
Avoid chilled, ready -to-eat foods: Soft cheeses. Takeaway chicken sandwiches. Cold meats. Pre-prepared or stored salads. Raw seafood. Smoked salmon & smoked oysters (can OK).
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EXERCISE
Reduced weight gain. More rapid weight loss after pregnancy. Improved mood. Improved sleep patterns.
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Exercise commonsense:
Take frequent breaks. Avoid exercise in extremely hot weather. Avoid unstable ground (joints more lax). Avoid contact sports. Avoid lifting weights over head. And weights that strain lower back muscles.
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Air Travel
Travel must be completed by 36th week. Medical clearance needed for twins & complicated pregnancy.
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Preventing DVT
Support stockings. Hydration. Ankle rolls, walks around plane. Baby aspirin.
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Stretch marks
Related to type of collagen ie genetic. May have link with pelvic floor & perineal stretchiness
Goanna oil, emu oil, olive oil,vitamin E and other expensive topicals..
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Vaginal Discharge
Normally increases with gestation. Exclude rupture of membranes. Canesten pessaries OK for thrush.
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Uncomfortables
Cant sleep! Swollen feet! Backache! sick of being pregnant!
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My back hurts...
Posture:
Dont slouch!, do not bend from waist. Choose chair with back support. Bra with support.
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Thank you
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