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Weeks 1-14
First trimester
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Weeks 15-28
Second Trimester
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Weeks 29-42
Third trimester
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Goal of prenatal care
↓ Morbidity & Mortality rate
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Cervical Softening
Hegar's sign
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Bluish discoloration of the cervix
Chadwick's sign
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Most accurate AOG if taken during 1st trimester
ultrasound
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Medical problems during pregnancy that puts patients at high risk
- Asthma
- Cardiac disease
- Diabetes mellitus
- Drug and alcohol use
- Epilepsy
- Family history of genetic problems
- Hemoglobinopathy
- HTN
- History of pulmonary/DVT
- Psychiatric illness
- Pulmonary disease
- Renal disease
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Factors for high-risk pregnancy
- >35 years at delivery
- Prior CS
- Incompetent cervix
- Prior fetal structural and chromosomal abnormality
- Prior neonatal death
- Prior fetal death
- Prior preterm delivery
- Prior low BW
- Second trimester pregnancy loss
- Uterine leiomyomas or malformation
- (+) HIV test
- Blood group isoimmunization
- Diagnosed condylomata
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Traditional schedule for prenatal care
- Every 4 weeks up to 28 weeks
- Every 2 weeks up to 36 weeks
- Weekly up to delivery
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Normal fetal heart rate
110-160 bpm
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Measurement of birth canal, usually done at term or during labor
Clinical pelvimetry
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Detectable by 16 to 29 weeks
fetal heart sounds
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Recommended weight gain for pregnant women
11.5-16 kg (25-35 lbs)
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Recommended weight gain for twin pregnancies
35-45 lbs (16-20 kg)
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Vitamins and minerals with potential toxic effects
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Extra calories needed during pregnancy
100 to 300 kcal/day
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Screening procedure to assess gestational DM
Glucose Challenge Test
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When to do Glucose Challenge Test
24th week
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Confirmatory test for gestational DM
OGTT
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Condition if no pregnancy after regular sexual contact w/o contraception for 1 yr
Primary infertility
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Indications for a baby with large birth weight (LBW)
- If baby weight is 4.8 kg & small mother
- Mothers w/ Gestational GM
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Whorl-like pattern of myometrial cell, if found very near the cervix, may interfere w/ Normal Vaginal delivery
Indicates CS delivery
Leiomyoma
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What are condylomata? What does it indicate?
genital warts; indicates CS delivery d/t risk of infection during vaginal delivery
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BP parameter for hypotension in pregnant women
110/70 mm Hg
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According to WHO, prenatal check-up for which weeks if no risk factors
26, 32, 38 weeks
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During PE, what should the physician focus on?
on the abdomen unless there is lung or cardiac complaints
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Maneuver to examine the uterus
Leopold's maneuver
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Growth of uterus during first trimester is dependent on what?
Estrogen
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During the second trimester, what does the size of the uterus indicate?
size of the fetus
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How to measure fundic height
Measure fundic height by putting tape measure at fundic hump to the pubic symphisis, straight line
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Measurement of fundic height at full term
35 cm
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How do you measure amniotic fluid?
Ultrasound
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When to perform Leopold's maneuver?
24 weeks
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Components of maternal evaluation:
- Blood pressure
- Weight
- Symptoms
- Fundic height in centimetres
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Range of fundic height that correlates with AOG
20-34 cm
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Average weight gain per week for pregnant women
1 lb/week
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Recommended protein intake during pregnancy
5-6 g /day
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Proteins that increase during pregnancy
Glutamic acid and alanine concentration ↑
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Iron requirement for singletons
27 mg/day
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60-100 mg/day of iron for which conditions
- Large women
- Twin pregnancies
- Anemia
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RDA for calcium
RDA 1000 to 1300 mg/day
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Which mineral deficiency?
Poor appetite
Suboptimal growth
Impaired wound healing
Zinc
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RDA for iodine
RDA 200 ug
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Which mineral deficiency?
Maternal subclinical hypothyroidism
Cretinism & neuro-development defects in the fetus
Seen in pt’s who live in high altitudes
Iodine
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Cause of magnesium deficiency
Deficiency due to pregnancy has not been recognized.
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Trace minerals required during pregnancy
- Copper
- Selenium
- Chromium
- Manganese
- Potassium
- Fluoride
- Magnesium
- Iodine
- Zinc
- Calcium
- Iron
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RDA Vitamin C
RDA 80 to 85 mg
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RDA Riboflavin
RDA 1.4 mg
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RDA Vitamin B6
RDA 1.9 mg
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Combine this with doxylamine to reduce vomiting
Vitamin B6
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RDA Vitamin B12
RDA 2.6 ug
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Deficiency of these vitamins will lead to neural tube defects
B12, folic acid
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Recommended Folic acid intake
4 mg before and during the 1st trimester
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RDA Vitamin A
RDA 750 to 770 ug
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Potentially teratogenic vitamin
Vitamin A
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Deficiency of which vitamin:
Anemia
Spontaneous preterm birth
Vitamin A
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Components of pragmatic nutritional surveillance
- Eat what she wants in amounts she desires and salted to taste
- Ensure the availability of food
- Monitor weight gain
- Periodically explore food intake
- Supplements: iron at least 27 mg, folate Recheck Hgb and Hct at 28 to 32 weeks.
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What is the concern re: fish consumption during pregnancy
Avoid fish with potentially high methylmercury levels (bottom-dwellers)
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Up to what week should pregnant women travel on airplanes
safe to travel up to 36 weeks
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What is the concern re: oral sex during pregnancy?
suffering from air embolism from partner blowing air inside vagina
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Recommended caffeine intake during pregnancy?
<300 mg/day
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Management for hyperemesis gravidarum
- Mild: vit B6 and doxylamine
- May also give phenothiazine or H1 receptor blocker
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Congenital predisposition
Can be present in the legs & perineum
Exaggerated with:
Prolonged standing
Weight increase
Length of time standing
Varicosities
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Treatment for varicosities
- periodic rest w/ legs elevated and use elastic stockings
- Lay down in lateral decubitus
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Tx for hemorrhoids
Rx. Topical anesthetics, warm soaks, stool softeners but better to ask patient to have high fiber diet
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Management for heartburn
- Small frequent meals
- Avoid bending or lying flat
- Antacids ex. AlMgOH
- High back rest when you lay down to decrease chances of reflux
- Eat small meals
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Condition that may be related to severe Fe deficiency anemia
Pica
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cravings of pregnant women for strange foods
can be non-food items such as ice—pagophagia, starch—amylophagia, or clay—geophagia may predominate.
Pica
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Usually unexplained: craving for unusual food
Women during pregnancy are occasionally distressed by profuse salivation.
Although usually unexplained, the cause of this condition sometimes appears to be stimulation of the salivary glands by the ingestion of starch.
Ptyalism
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Fatigue can be due to the effects of this hormone
progesterone
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May be normal in pregnancy
thick, whitish or yellowish vaginal discharge
Due to hyperestrogenemia
But may predispose to bacterial vaginosis, candidiasis, trichomoniasis.
d/t pH form 3.5 to 6
Leukorrhea
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