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Prenatal care and pregnancy diagnosis (Pregnancy diagnosis (Symptoms of…
Prenatal care and pregnancy diagnosis
First appointment before the 10th week
History and physical exam, vaginal exam
Blood pressure, Breast exam
Woman’s height and weight, Pregnancy risk assessment
Promoting healthy lifestyle
Information about possible screening for fetal aneuplodies
If pregnancy is followed by midwife – specialist consultation
Laboratory tests:
Blood group, Antibodies against blood group antigens
CBC (complete blood count), Urinalysis
PAP smear, Microbial vaginal smear
Fasting glucose, VDRL (syphilis), Dental exam
HIV and HCV, Toxoplasmosis (IgG and IgM) and rubella
Frequently additionally performed: Cytomegaly, TSH, fT4
11-14th week visit
History and physical exam
Speculum and vaginal exam, Blood pressure
Woman’s weight, Pregnancy risk assessment
Promoting healthy lifestyle (mouth hygene)
Checking the condition of oral cavity
1st trimester ultrasound
Laboratory tests:
1.Urinalysis
biochemical screening for aneuploidies (double test, PAPP-A test)
15-20th week visit
Laboratory tests:
CBC, Urinalysis
Microbial vaginal smear
Pap smear if not done earlier
Additional test: AFP
History and physical exam, Speculum and vaginal exam
Blood pressure, Woman’s weight
Pregnancy risk assessment
Promoting healthy lifestyle (mouth hygene)
21-26th week visit
Ultrasound examination
Laboratory tests:
Oral glucose tolerance test (OGTT – 0’, 60’, 120’) at 24-28 weeks
Urinalysis, Anti-Rh antibodies in Rh negative patients
Toxoplasmosis in patients sero-negative, Pap smear if not done earlier
History and physical exam, Speculum and vaginal exam
Fetal heart rate assessment, Blood pressure
Woman’s weight, Pregnancy risk assessment
Promoting healthy lifestyle (mouth hygene)
Checking the condition of oral cavity
Practical and theoretical preparation for labor, puerperium, breastfeeding and parenthood (in groups or individual)
27-32nd week visit
Ultrasound examination
Lab.
CBC, Urinalysis
Antibodies against blood group antigens
anti-RhD immunoglobulin administration
Pap smear if not done earlier
History and physical exam, Speculum and vaginal exam
Fetal heart rate assessment, Blood pressure
Woman’s weight, Pregnancy risk assessment
Promoting healthy lifestyle (mouth hygene)
Practical and theoretical preparation for labor, puerperium, breastfeeding and parenthood (in groups or individual)
Leopold’s Maneuvers
first maneuver: to determine which fetal part is lying furthest away from the pelvic inlet
second maneuver: to determine the location of the fetal back
third maneuver: to determine which fetal part is lying above the pelvic inlet
fourth maneuver: to locate the fetal forehead
33-37th week visit
History and physical exam, Obstetrical exam
Pelvis diameters assessment, Speculum and vaginal exam
Fetal heart rate assessment, Blood pressure
Fetal activity assessment, Breast exam
Woman’s weight, Checking of the condition of oral cavity
Pregnancy risk assessment, Promoting healthy lifestyle (mouth hygene)
Practical and theoretical preparation for labor, puerperium, breastfeeding and parenthood (in groups or individual)
If pregnancy is followed by midwife – specialist consultation
Laboratory tests:
CBC, Urinalysis, Microbial vaginal smear
HBs, HIV, Vaginal and anal smear for GBS
VDRL and HCV in women in high-risk group
Pap smear if not done earlier
In GBS positive patients (carriers) – don’t treat! perinatal prophylaxis with antibiotics
38-39th week visit
History and physical exam, Obstetrical exam
Fetal heart rate assessment, Fetal activity assessment
Blood pressure, Woman’s weight, Pregnancy risk assessment
Promoting healthy lifestyle (mouth hygene)
Practical and theoretical preparation for labor, puerperium, breastfeeding and parenthood (in groups or individual)
If pregnancy is followed by midwife – specialist consultation
Laboratory tests:
Urinalysis
CBC
40th week visit
History and physical exam, Obstetrical exam
Speculum and vaginal exam, Fetal heart rate assessment
Fetal activity assessment, Blood pressure, Woman’s weight
Pregnancy risk assessment, Promoting healthy lifestyle (mouth hygene)
Practical and theoretical preparation for labor, puerperium, breastfeeding and parenthood (in groups or individual)
Referral to the hospital after 41 weeks
Other tests:
1.CTG
2.Ultrasound
Physical activity:
Increased risk mainly of preterm birth
Not recommended:
Hyperthermia – sauna, extreme excercises
Sports with higher trauma risk: skiing, surfing, horse riding, skating
Physical activity should be slightly decreased as pregnancy advances
Sexual activity
In normal pregancy – usual sexual activity;
In infections of vagina or urinary tract, short cervix or placenta praevia – sexual activity increases the risk of misscariage, preterm delivery or PROM
The position should be adjusted to avoid abdomen or breast compression
Intercourses in the last 6 weeks of pregnancy can stimulate the uterine contractions and preterm delivery – not in healthy pregnancy
Bleeding:
Slight bleeding (spotting) in the first few weeks of pregnancy may appear
No need for treatment
Pre-conception visit
Laboratory tests:
toxoplasmosis, cytomegaly, rubella, HIV, thyroid hormones, vitamin D3
Vaccinations:
hepatitis B, varicella zoster, rubella (3 months), measles (3 months), mumps (3 months), tetanus, pertussis
Supplementation:
folic acid 0.4 mg (4 mg if patient is taking anti-convulsants, gave birth to a child with NTD, heart defect or defect of abdominal wall) – prophylaxis of NTD
iodine 150-200 µg – prophylaxis of hypothyroidosis
vitamin D3 2000 u
Aim
early detection of:
problems with fetal development
onset of maternal complications or aggravation of existing diseases
Pregnancy diagnosis
Blood or urine pregnancy test – hCG positive in serum 9 d post-conception, positive in urine 28 d after first day of LMP
Transvaginal ultrasound – till 7th day after expected menstruation gestational sac may be invisible
Due date
Naegele rule (regular cycle)
Estimation basing on the conception date
US:
the best CRL up to 11 weeks
later BPD, FL – no later than 19 weeks
Symptoms of pregnancy
Implicit:
Nousea and vomiting, anorexia, better apetite, Dizziness
Polyuria - pressure of uterus on urine bladder, Constipation
Increase in temperature
Probable:
Menstrual period loss, enlargement of uterus, enlargement of mammary glands, change in colour of vulva and vestibulum of vagina, stretch marks, pigmentation of linea alba and mammary gland areola
Certain:
fetal heart rate, fetal movements, palpation of fetal parts
Vaginal symptoms
Labhardt symptom – change in color of mucosa around urethra; blue color of vagina, vagina is wider and more stretched
Chadwick symptom – blue color of vaginal part of cervix
increase in mucus production
Uterus symptoms
Enlargement of the uterus corpus
uterus symptoms:
Holzapfel’s (rough surface peritoneum)
Piskaćk’s (enlargement of one of uterine horns )
Nobleg’s (uterus corpus in the lateral fornix)
Lönneg’s ( increase of anteflexion)
Hegar’s ( mobility of corpus in relation to the cervix, softening of the cervical isthmus (6-8 wk))
Pschyrembla - lateral part of cervix is soft and the middle part is hard
Ossiander’s (heart rate on descending part of uterine artery )
Goodell’s sign: softening of the cervix (4-6 wk)
Chadwick’s sign: bluish discolouration of the cervix and vagina due to pelvic vasculature engorgement (6 wk)
Enlargement of uterus corpus
8 tc. – as big as goose egg
12 tc. – as big as man’s fist
16 tc. –2 fingers above syphisis pubis
20 tc. – 3 fingers below the umbilicus
24 tc. – at the level of umbilicus
28 tc. – 2 fingers above the umbilicus
32 tc. – in the midddle between umbilicus and vertebra
36 tc. – at the level of vertebra
40 tc. – 3 fingers below the vertebra
Fetal movements
Primipara: app. 17-19 weeks
Multipara: app. 15-19 weeks
Teratogenic factors
Environmental factors
Malnutrition, Maternal infections, Maternal diseases
Chemical factors
Medicines, Drugs, Hormones
Physical factors
Ionizing radiation, Extremal temperatures, Ultrasound waves
Job activity
Influence of:
chemical factor, electromagnetic field, noise, moving tools
Contraindicated:
night work, exceeding 8 hours, physical or psychological tension, strained position
To be considered:
position change, abstaining from work
Travel
No direct influence on pregnancy
Possibility of more frequent position change
Seat-belts have to be fastened
Air journeys not contraindicated, however, in long-distance flights the use of compression socks is advised
Leisure journeys to the tropical countries are relatively contraindicated due to the risk of overheating and exposure to infectious diseases.
Increased vaginal discharge
Excretion consists of:
cervical mucus
exfoliated vaginal epithelium cells
white-grey color
caused by hormonal stimulation
if there are no infection symptoms, does not need any treatment
Expectant couples training
Learns:
what is the course of delivery
how to cope with pain
how to take care of the baby
how to breastfeed and maintain milk production