Obstetrics

Prenatal Care

  • Definitions

    • Gestational age (GA): Time of pregnancy counting from the first day of the last menstrual period (LMP).

    • Developmental age: Time of pregnancy counting from fertilization.

    • Trimesters: First (0-13 weeks), Second (14-27 weeks), Third (28 weeks-birth).

    • Embryo: Fertilization-8 weeks.

    • Fetus: 9 weeks-birth.

    • Previable: < 24 weeks.

    • Preterm: 20-36 weeks.

    • Term: 37-42 weeks.

    • Gravidity (G): Total number of pregnancies regardless of outcome.

    • Parity (P): Number of pregnancies reaching ≥ 20 weeks.

  • Frequency of Obstetric Visits

    • < 28 weeks: Every month.

    • 28-36 weeks: Every 2-3 weeks.

    • 36-41 weeks: Once weekly.

    • 41-42 weeks: Every 2-3 days for fetal testing.

    • 42 weeks or more: Plan for delivery.

  • First Visit:

    • Include history, labs, fetal heart tones, infection screen, urine analysis, etc.

  • Subsequent Visits:

    • Check fetal movement, vaginal bleeding, and preeclampsia symptoms.

Fetal Surveillance

  • Fetal Movement Counts: Monitor at home.

  • Non-Stress Test (NST): Assesses fetal heart rate with contractions.

    • Reactive NST: Normal acceleration patterns.

    • Non-reactive NST: Further testing needed.

  • Contraction Stress Test (CST): Measures FHR response to contractions.

  • Ultrasound: Evaluates fetal health and structure.

  • Biophysical Profile (BPP): Combination of NST and ultrasound exam.

Screening for Congenital Abnormalities

  • First-Trimester Screen (FTS): Combines blood screening with ultrasound evaluation for risk of Down syndrome.

  • Quad Screen: Maternal serum assessment for trisomy risk.

  • Amniocentesis and Chorionic Villus Sampling (CVS): Used for genetic testing.

Nutritional Needs of the Pregnant Woman

  • Weight Gain Recommendations:

    • Normal BMI: 25-35 lbs.

    • Underweight: 28-40 lbs.

    • Overweight: 15-25 lbs.

  • Dietary Requirements:

    • Increased caloric intake, focus on high protein, vitamins (especially folic acid), and minerals.

  • Common Nutritional Deficiencies:

    • Iron, calcium, zinc among vegetarians.

Common Questions in Pregnancy

  • Caffeine and Exercise: Moderate intake allowed; regular exercise encouraged unless contraindicated.

  • Nausea and Vomiting: Common; management includes dietary adjustments.

  • Backache and Leg Cramps: Many women experience these; supportive measures recommended.

Postpartum Considerations

  • Immunizations: Delay certain vaccines until after the first trimester. Monitor for warning signs post-delivery.

  • Notify Physician if: Vaginal bleeding, severe abdominal pain, fever, changes in fetal movements occur.