Beruflich Dokumente
Kultur Dokumente
History
Should Include:
Chief Complaint
Patients age
Marital status
Gravidity and parity
Last menstrual period (LMP)
Previous usual menstrual period (PUMP)
Expected date of delivery (EDD)
Occupation
Father of the baby and his occupation
Present Problem
Description of current PG
Previous medical/health care
Attention should be given to specific
problems
Nausea
Vomiting
Fatigue
Edema
Obstetric History
of delivery
Length of PG
Weight and sex of infant
Length of labor
of delivery
Spontaneous vaginal
Induced vaginal
Cesarean
Spontaneous or elective abortion
Complications
Pregnancy
Labor
Postpartum
or with the Infant
Medical History
to environmental and
occupational hazards
Medical History
NOTE:
Family History
In addition to the usual family Hx
Genetic conditions
Twins
Congenital anomolies
towards the PG
Whether the PG was planned
Preference for sex of child
Social supports available
Experiences with mothering
History of abuse in relationships
Review of Systems
Effects of PG are seen in all systems.
system
Cardiovascular system
Endocrine system
Diabetes
Urinary tract
Infection
Kidney
function
Respiratory function
May
be compromised
later PG
tocolytic therapy for preterm labor
Risk Assessment
Identify from the Hx and physical exam
those conditions that threaten the wellbeing of the mother and/or fetus.
Diabetes
Pre-term labor
Preeclampsia
Eclampsia
Pregnancy-induced hypertension (PIH)
Weight Gain
Weight Gain
Weight Gain
Placenta
Amniotic fluid
Uterus
Blood and fluid volume
Breasts
Fat reserves
Weight Gain
Weight Gain
Weight Gain
Weight Gain
1st
variable
2nd
0.3-1.5 lb / week
3rd
0.4-1.4 lb / week
TOTAL
25-35 lbs
Always consider
Please Note
lbs
often seen in adolescents
Nutritional Considerations
Prepregnancy
Folate:
During pregnancy
Protein
Calories
Iron
Folate
Calcium
Nutritional Considerations
Lactation
Calories
Protein
Calcium
Vitamins
Pica
A and C
Overview
Striae gravidarum
Telangiectasias
Hemangiomas
Cutaneous tags
Increased pigmentation
Linea
nigra
Chloasma
Striae Gravidarum
Stretch marks
May appear over the abdomen,
thighs, and breasts
2nd trimester
Telangiectasias
Vascular Spiders
May be found on the face, neck,
chest, and arms
Appear during the 2nd-5th month
Usually resolve after delivery
Hemangiomas
Cutaneous tags
Increased Pigmentation
and nipples
Vulvar and perianal regions
Axillae
Linea alba
Linea Nigra
Pigmentation of
the linea alba
Chloasma
Mask of Pregnancy
70% of pregnant women
Hyperpigmentation
forehead,
cheeks, bridge
of nose, and chin
Mask of Pregnancy
Palmar Erythema
Itching
from stretching
Common; not a concern
Generallized itching
Starts
Hair Growth
Altered by hormones
Acne Vulgaris
Thyroid
Thyroid
Eyes
Corneal Changes
trimester
Krukenberg Spindles
Diabetic Retinopathy
Contact Lenses
sensation
blurred vision
reasons
Subconjunctival hemorrhages
occur
spontaneously in pregnancy or
during labor
resolve spontaneously
Retinal Examination
Retinal Examination
Chronic Hypertension PIH
Vascular tortuosity
Angiosclerosis
Hemorrhage
Exudates
Segmental arteriolar
narrowing with a
wet, glistening
appearance (edema)
Rare
Rare
Nasal stuffiness
congestion, sinusitis
Gums
increased
Laryngeal Changes
Hoarseness
Deepening
Tympanic membrane
increased vascularity
retracted or bulging with serous fluid
Anatomic Changes
Costal angle
68 degrees ~> 103 degrees
(before PG)
(3rd trimester)
Anatomic Changes
Progesterone
Dyspnea
Adaptation
Increased
vital capacity
Increased tidal volume
Heart Compensates
Cardiac Output
Increases 40-50%
Reaches its highest level by 24
weeks and is maintained until term
Returns to pre-pregnancy levels
about 2 weeks after delivery
Heart Position
Apical pulse
upward
Heart Sounds
splitting of S1 and S2
S3 may be heard after 20 weeks
Grade II systolic ejection murmurs
heard over the pulmonic area in 90%
of PG women
intensified during inspiration or
expiration
erythema
Spider telangiectases
edema
Varicosities of the legs and vulva
Hemorrhoids
Heart Rate
Blood Pressure
sustained
systolic BP >140 mm Hg or
diastolic pressure >90 mm Hg
1st Tri
2nd Tri
3rd Tri
Labor &
Delivery
HR
Increased
Peaks at
Slightly
Increased & Pre- w/in
28th week decreased Bradycardia 2-6 weeks
at delivery
BP
Pre-
Slightly
Predecreased
BV
Increased
Peeks at
20th week
Gradually Rises
decreased sharply
Pre- w/in
2-6 weeks
SV
Increased
Peeks at
28th week
Gradually Decreased
decreased
Pre- w/in
2-6 weeks
CO
Increased
Peeks at
20th week
Slightly
Increased
decreased
Pre- w/in
2-6 weeks
Pre-
Postpartum
Pre- w/in
2-6 weeks
Areolae
more
deeply pigmented
diameter increases
Nipples
more
glands hypertrophy
Secretory Activity
2nd trimester
Vascular
Bluish in color
Do not blanch
Abdomen
Auscultation
Bowel sounds will be diminished as a
result of decreased peristaltic activity
Inspection
Striae and linea nigra may be present
Linea
age
Fetal growth
Position of the fetus
Monitoring of fetal well-being
Gestational Age
Fetal Well-Being
Assessment includes
Fetal heart rate (FHR)
Fetal movements
Fetal Position
Leopolds
maneuvers