apgar and pregnancy lecture notes

8/4/2019 Apgar and Pregnancy Lecture Notes

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Obstetrics - deals with phenomenon and management of labor and delivery.

- Latin word obstetrix-> midwife

Pre-Natal Check-up

1. Early Identification of risk factors during pregnancy.

2. Early Management of problems

3. Decrease both maternal and infant mortality and morbidity.

Prenatal Check-up

According to DOH minimum of5 Prenatal Check-up:1st trimester = 1st visit

2nd trimester = 2nd visit

3rd trimester = 3rd visit9th month = 2x every other week

According to OB Book1st - 6th month = once a month

7th 8th = twice a month9th = weekly

Components of PNC (Prenatal Check-up)1. Hx taking

A. Demographic Profile

Age (at risk18 35 y/o) Ht ( 42 weeks

Nulligravida = never been pregnant (0 pregnancy) Primigravida = 1st pregnancy

Multigravida = 2 or more pregnancy Grandmulti = 5 or more pregnancy


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AOG Taking

a) Mcdonalds Rule =determines AOG in month by measuring from the fundusto the symphisis pubis (cm).

Fundic Height in cm x 8 =AOG in wks7

b) Bartholomews Rule = estimate AOG by the relative position of the uterus in the

abdominal cavity.

EDC Taking

a) Naegele's Rule is a standard way of calculating the due date for apregnancy.

LMP ( January- March) +9 MOS + 7 DAYS

( April- Dec) -3 MOS + 7 DAYS + 1 YEAR

Ex. LMP = 8 May 2007+1 year = 8 May 2008 -3 months = 8 February 2008 +7 days = 15 February 2008

Head to toe Assessment of Pregnant Women

Normal Change Abnormal Change

Skin Pallor (1st trimester) 2nd and 3rd trimester

Cheeks, nose andneck

Chloasma / Melasma -

Head - Headache

Eyes - Visual Disturbances (eye

problem)

Ears - Tinnitus

Nose - Epistaxis

Mouth Dental caries (tooth

decay)

Streptococcus infection

8th months

(below xiphoid process)

9th months

5th months

(umbilicus)

1 month

(symphysis pubis )
http://en.wikipedia.org/wiki/Due_datehttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Due_datehttp://en.wikipedia.org/wiki/Pregnancy


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Neck Slightly enlarged Very enlarged

Chest SOB DOB

Palpitation

Breast Enlarging Normal color Mastitis Redness

Abdomen Striae Gravidarum -

Linea Nigra -

GI ConstipationPyrosis

Morning sickness Hyperemesis Gravidarum

Renal Urinary Frequency -

Muskuloskeletal Lordosis low back

pain

-

Leg cramps

hypocalemia

-

Extremities Edema -

Varicosities -

Genitals Chadwicks sign -

Goodles sign -

Hegars sign -

IMPORTANT TERMINOLOGIES

A) SYSTEMIC CHANGESNormal Adaptations in Pregnancy (CGRUMTEEW)

I. Circulatory/ Cardiovascular- 1st trimester

a) Increase Cardiac Output (30-50%)

-Hgb and Hct Decrease > Anemia of Pregnancy

-Easy Fatigability and SOB > Increase cardiac workload

-Epistaxis > Increase congestion of blood in the nasopharynx

b) Palpitations

> Increase pressure of uterus against the diaphragm

c) Edema on the Lower Extremities

> Poor circulation because of the pressure created by gravid uterus.MANAGEMENT: Raise leg above hip level

d) Varicosities

MANAGEMENT: Use Stockings to prevent stasis in lower extremities, avoid elastic bandage

*Vulva and Rectum> RLSP with hips elevated or modified knee chest

II. Gastrointestinala) Morning Sickness

-Increase in Hcg> Increase production of gastric acid -> Heartburn!MANAGEMENT: Crackers, low fat, low spices

***Hyperemesis Gravidarum- excessive nausea and vomiting-> Dehydration and starvation!

b) Constipation and Flatulence


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A. Stomach is displace -> slow peristalsis and gastric emptyingB. Increase progesterone -> inhibit gastric motilityMANAGEMENT: Increase fluid intake and roughage in diet, avoid enema (habit)

c) Hemorrhoids

-pressure of enlarge uterus in the intestine.MANAGEMENT: Cold compress with hazel or Epson salt

d) Heartburn

-last trimester

-Increase progesterone -> decrease gastric motility -> reverse peristaltic waves -> regurgitationof acid in stomach -> esophagus; irritationMANAGEMENT: Avoid spicy foods, sips of milk, small frequent meals, antacids, never

bicarbonates-> EDEMA!

III. Respiratorya) Shortness of breath

- Increase oxygen consumption and product of carbon dioxide-Increase uterus size -> diaphragm will be pushed and displace -> crowding chest cavity

MANAGEMENT: Adequate rest (10-15 minutes)

IV. Urinary

-1st

and 3

rd

trimester(1st trimester) -> Increase blood supply in the kidneys

(3rd trimester) -> Enlarged uterus-Decrease renal threshold for sugar GLYCOSURIA -> due to increase glucocorticoids ->

lactose and dextrose spill into urine

V. Musculoskeletala) Lordosis Pride of Pregnancy

-Increase relaxin production -> pelvic bone movable -> increase accidental fall -> wobbling

gait PATOMANAGEMENT: Low healed shoes

b) Leg Cramps

-Increase pressure of the gravid uterus on the lower extremities-Low calcium level-Fatigue and muscle weakness

VI. Temperature-Increase in progesterone -> slightly increase in Basal Body Temperature (BBT)

VII. Endocrinea) Thyroid Gland enlargement

-due to hyperplasia of glandular tissue & increase vascularity

VIII. Emotional1st trimester - Rejection

2nd trimester - Fantasize

3rd trimester - ResponsibilitiesIX. Weight

*minimum weight gain- 20-25 lbs*maximum weight gain- 25-35 lbs

***NORMAL: 24-30 lbs -> water retention of 7 liters

B) LOCAL CHANGESNormal Adaptations in Pregnancy (UVOABs)


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I. Uterusa) Hegars isthmus softening

b) Goodells cervix and vagina softening

c) Braxtons Hick Contraction painless contraction (3rd or 4th months)

II. Vaginaa) Chadwicks bluish discoloration

-Increase vascularity -> change in color-> light pink -> purple or violet

III. Ovaries-no production of FSH and HCG -> does not produce OVA

IV. Abdominal Walla) Striae Gravidarum (stretch marks)-> rupture and atropy of connective tissue (pink or reddish streak)

b) Umbilicus Pushed out

->pressure

V. Breast

-Increase estrogen -> preparation for lactationa) Nipples erect

-areola becomes darker and colostrum is formed

b) Production of colostrum and estrogenVI. Skina) Linea Negra

-brown line from umbilicus to symphysis pubis

b) Chloasma Mask of pregnancy

-pigmentation of the cheeks across the nose -> Increase production of melanocytes by thepituitary gland (MSH)

APGAR SCORING-developed by Virginia Apgar

Scores 3 and beloware generally regarded as critically low,

4 to 6fairly low, and7 to 10 generally normal.

apgar and pregnancy lecture notes

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