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Antenatal care :<3: (:sunflower: Antenatal care (:book: Prenatal record…

- - - - :leaves: S&S
        
        Morning sickness
        
        Fatigue
        
        Quickening
        
        Amenorrhea
        
        Chadwick signs dark-bluish red & congested vaginal mucosa
    - - :leaves: Signs
        
        Enlarged uterus
        
        Hegar signs (soften uterus)
        
        Goodell signs (soften cervix)
        
        Fetal parts palpation by physician
        
        Positive pregnancy test
        
        hCG hormone (human chorionic gonadtropin) so can be detected in maternal Serum or Urine by 8-9 days after ovulation
    - - :leaves: Signs
        
        Fetal heart detection (via steth, u/s)
        
        Fetal movement detection (by physician)
        
        U/S detection
- - - - currently preg or has been in the past
        (ไม่สนใจ preg outcome)
    - - been delivered with ≥ 20 weeks
        (ไม่สนใจผลการคลอด)
  - - - 280 days or 40 wks from LMP
      - EDC/EDD = LMP + 7 days - 3 months in the next following year Naegele rule
    - - 1st trimester: First 14 wks
      - 2nd trimester: 14-28 wks
      - 3rd trimester: 28-42 wks
- - - - Wt gain ranges based on prepregnancy BMI
      - Total wt gain = 11-15 kg (Normal BMI pt)
      - recommend Caloric increase of 100 - 300 kcal/day during pregnancy
    - - Purpose
        
        expanding maternal Hb mass
        
        Transferred to fetus and placenta
      - Doses
        
        ≥ 27 mg of elemental iron supplement daily
        
        Not necessary in First 4 months of preg
    - - Preventive dose of NTD
        
        400 μg daily during periconceptional period
        (gives 3 months before preg)
      - Treatment dose
        
        4 mg daily if there's Hx of NTD in previous preg
  - - - No need to limit exercise
      - Rec moderate intensity
      - :no_entry: C/I: HT, Preterm labor, PPROM, placenta previa
    - - Teeth examination should include in prenatal examination
      - Periodontal ds link to Preterm labor
    - - :heart_eyes: recs Influenza vaccine, Tetanus-diphtheria acellular pertussis (Tdap)
      - :warning: Avoids Live-attenuated Vaccine (MMR)
- - - - Wt, Ht, BMI, V/S
      - General examinations
      - Leopold's maneuver
      - Pelvic examination
      - :star: GA assessment
        
        uses
        
        Hx: LMP
        
        PE: Leopold's
        Then, confirmed by U/S for EDC (esp U/S in 1st trimester ) = most accurate method to confirm GAtext
        
        Guidelines for Redating Based on U/S :grapes:
    - - Past Hx (Previous health status)
      - FxHx (Genetic Ds)
      - Social Hx (smoking, drinking)
      - :star:OB-GYN Hx (previous preg, LMP)
      - Symptoms of preg
    - - CBC (Hb, Hct)
      - Blood group, Rh group*
      - Serology (HIV, Syphilis, HBV)
      - PAP smear (optional)
      - *when indicated only
        
        Hb typing
        
        50 gm glucose challenge test (GCT)
        
        ± BUN, Cr, Urine protein (2nd trimester up)
  - - - :large_blue_diamond: WHO
        
        AVG visits = 5 visits
        
        In 1st trimester + screened for certain risk
        
        @ 26 wks
        
        @ 32 wks
        
        @ 38 wks
      - Classic
        สมัยก่อน
        
        Complicated
        
        require return visits at 1-2 week intervals
        
        Uncomplicated
        
        q 2 wks until 36 wks
        
        q 1 wk after that
        
        q 4 wks until 28 wks
    - - Assessment of Well-being of Mother & Fetus
        
        :leaves: S&S
        
        Mom: headache, altered vision, abd pain, N/V, bleeding, Vx fluid leakage, and dysuria
        
        Fetus: FHR, growth, amnionic fluid volume, and activity
        
        :yellow_heart: PE Leopold's maneuver
        
        Fundal height exam
        
        Distance along abd wall fr Pubic symphysis to Top of fundus
        
        :small_blue_diamond: Jimenez: between 20-34 wks Ht of uterine fundus in cms correlates closely with GA in weeks
        
        :male-scientist: Labs
        
        Hb, Hct, Serology (SY, HIV) repeated at 28 - 32 wks
        
        Screening test for GDM in all preg women at 24 - 28 wks