Professional Documents
Culture Documents
Involves:
o Identification of factors that affect perinatal
outcome
o Information of risk to mother
o Information of strategy to reduce or eliminate
the influence of risk factors
Prior to conception
Benefits:
disease
Exacerbation of renal hypertension
Superimposition of preeclampsia
Pregnancy increases progression of renal damage in
severe disease
Fetal risk related to associated vascular dysfunction
Best predictor of perinatal outcome is serum creatinine
level
ACE inhibitors are contraindicated
Hyoertension
May worsen during pregnancy
May need additional drug therapy
Assessment of renal & cardiac function
Fetal risks : related to maternal BP control
Maternal risk: related to superimposition of
preeclampsia
Epilepsy
Increased seizure activity during pregnancy
Related to reduce drug level
Offspring of epileptic women at increased risk for
o Structural malformation
- Related to anti-epileptic meds
- Monotherapy is advocated
o Seizure disorder
Monotherapy significantly fewer malformations than
multitherapy
Cardiac disease
Pregnancy associated mortality related to the type of
cardiac lesions
Highest mortality risks:
o Pulmonary risk
o Complicated aortic coarctation
o Marfans syndrome w/ aortic involvement
Cyanotic heart disease: increased risk
o Obtain a pedigree analysis to quantify the fetal
risk
Thromboembolism/Thrombophilias
Maternal risks
o Pulmonary embolism
o Cerebral infarction
o Early preeclampsia
o Increase risk of recurrence
Fetal risks
o Preterm
o Stillbirth
o Abortion
o Fetal growth restriction
Connective tissue disease
Pregnancy associated risk vary w/ the type of CTD
Prenatal Evaluation
Initiated as soon as there is likelihood of pregnancy
Should be no later than the 2nd missed period
Goals:
o Determine the health status of the mother and
fetus
o Determine the gestational age of the fetus
o Formulation of a plan for continuing obstetrical
care
o Perinatal mortality
o Preterm delivery
o Fetal growth restriction
o Fetal malformations
o Placental accidents
o Maternal hemorrhage
c) Evidence of maternal undernutrition
Estimated due date
General physical examination
Laboratory tests
Patient education
Definitions:
Parity number of pregnancies reaching viability ( 20
weeks, 500 gm) and not number of fetuses deliverd
Primipara woman who has delivered only once of a
fetus or fetuses who have reached viability
Multipara a woman who has completed two or more
pregnancies to viability
Nullipara a woman who has never completed a
pregnancy beyond an abortion
Gravida a woman who is or has been pregnant regardless
of outcome
Nulligravida a woman who is not now , and never has
been pregnant
Primigravida a woman who is or has been pregnant
only once
Multigravida a woman who is or has been pregnant
more than once
Parturient a woman in labor
Puerperal a woman who has just given birth
Obstetric index series of digits connected by dashes that
denotes past obstetrical history
Obstetrical index (a-b-c-d)
First digit (a) number of term infants
Second digit (b) number of preterm infants
Third digit (c) number of abortions, ectopic or molar
pregnancies
Fourth digit (d) number of children currently alive
Ex. G9P7 (6-1-2-6)
9 pregnancies
7 deliveries
6 term deliveries
1 preterm delivery
2 pregnancies not reaching viability
6 currently alive children
Normal duration of pregnancy
280 days or 40 weeks, calculated from the first day of
the last normal menstrual period
Estimated date of delivery (EDD)
o Calculated using Naegeles rule
o Add 7 days to the first day of LMP; count back 3
months
Trimesters of pregnancy
3 equal period consisting of 3 calendar months
1st trimester: up to 14 weeks
2nd trimester : 14 weeks 1 day up to 28 weeks
3rd trimester : 28 weeks 1 day up to 42 weeks
Gestational age
Expressed in weeks
Computed from
o LMP
o Ultrasound
Correlate with uterine size, quickening and detection of
FHT
Ascertained by a carefully done clinical examination
coupled with an accurate knowledge of the tie of
onset of the last menstrual period
Bowel Habits
Constipation common
o Prolonged transit time
o Compression of the lower bowel by uterus or the
fetal presenting part
Greater frequency of hemorrhoids
Coitus
Not harmful until the last 4 weeks or so of pregnancy
Avoided when there is a risk for abortion or preterm
labor
Care of teeth
Pregnancy is rarely a contraindication to dental
treatment
Dental carries aggravated by pregnancy is unfounded
Immunizations
Live virus vaccines
o Measles
o Mumps
o Varicella Zoster
Live bacterial vaccines
o Typhoid : risks vs benefit
o Poliomyelitis : no longer recommended
o Yellow fever : high-risk areas only
Inactivated virus vaccine:
o Influenza : after 1st trimester request
o Rabies : same as non pregnant
o Hepatitis A and B : same as non pregnant
o Enhanced poliomyelitis : risk of exposure
o Japanese encephalitis : risk vs. benefit
Inactivated bacterial vaccines
o Pneumococcal : same as non pregnant
o Meningococcal : same as non pregnant