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14: 35yo missed period (screening (only if risk factors (hep c, varicella…
14: 35yo missed period
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testing - blood hCG levels double every 2.2 days and then every 3.5 days by 9 weeks. peak at 10-12 wks, decline until 22wks and rise until delivery
transvaginal U/S 4-5 weeks can see gestational sac, fetal pole at 5-6 weeks
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prenatal hx
medical, obstetric, genetic risk factors, social
screening
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urinalysis
every prenatal visit , for proteinuria, glycosuria,
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only if risk factors
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herpes - if active, need antiviral
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Prenatal f/u
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18-20weeks
u/s for anomalies
AFP, hug, unconjugated estriol, dimeric inhibitn A = neural tube defects/trisomy 21/18 done at 15-21weeks 80% sensitivity for down syndrome
can see sex, hair, fingerprints
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23 weeks
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talk - breastfeeding, car seat, contraception
27 weeks
BP - chronic HTN, gestational [no proteinuria], preeclampsia [proteinuria >0.3g/24hrs], eclampsia [convulsions]
severe preeclampsia - visual disturbance, HA, RUQ pain, N/V, decreased UOP
gestational diabetes screen - >=2 of four glucose measurements over cutoffs [1hr >180; 2hrs >155; 3hr >140]
risks: preeclampsia, fetal macrosomia, birth trauma, c-secton need, neonatal mortality, newborn complications
36 weeks
testing
Group B strep. give intrapartum antimicrobial prophylaxis for prior hx. treat with penicillin or ampicillin
complications
placenta previa
0.5% of patients, more common in older, smoking, women with multiple pregnancy or uterine surgery
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if placenta attaches low in uterus, cover os, bleeding later in pregnancy
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pregnant rashes
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treat: topical steroids, antihistamines
post-partum
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contraception
progestin only, deposed, implanon but may affect milk so wait 6 weeks
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