OB Q2 Study Guide (Dr.Paz) Comprehensive Study Notes on Pregnancy and Maternal Health

Pregnancy Overview

Trimester Details

• First Trimester

  • Urgency and frequency of urination common

  • Duration: from conception to 12 weeks

• Third Trimester

  • Urgency and frequency reappear

Fundal Height Measurement

• Expected Fundal Height at Umbilicus:

  • At 20 weeks gestation

• Growth Rate of Fundus

  • Increases by 1 cm per week after 20 weeks

  • Example: 21 weeks = 21 cm, 22 weeks = 22 cm, etc.

Lifestyle Considerations

• Tobacco Use

  • Recommendation: No smoking

  • Risks:

  • Neural tube defects

  • Preterm labor

  • Low birth weight

  • Possible link to schizophrenia/mental illness

• Alcohol Use

  • Recommendation: No alcohol

Indirect Coombs Test

• Purpose: Identifies anti-Rh antibodies in mother

Exercise During Pregnancy

• Recommendation: Mild to moderate exercise allowed

• Types of Exercises:

  • Stretching

  • Yoga

  • Walking

• Prohibitions:

  • No weight-bearing exercise

  • No jumping

• Rest Period:

  • Recommend resting for at least 10 minutes post-exercise

Nutritional Intake

• Daily Recommended Intake of Folate (DRI):

  • 600 micrograms

• Iron Supplement Guidance:

  • Side effects: Black stools, constipation

  • Iron needs are increased during pregnancy

  • Vitamin C enhances iron absorption (citrus fruits)

Serum Alpha-Fetoprotein Levels

• Increased Levels: Risk for neural tube defects

• Decreased Levels: Risk for Down syndrome

Fetal Movement Detection

• First Maternal Movement (Quickening):

  • Typically occurs between 16 to 20 weeks gestation

  • May also be reported between 14 to 18 weeks

Maternal Weight Gain Recommendations

• Normal BMI: 20 to 35 lbs

• Overweight (Pre-pregnancy BMI 25-29.9): 15 to 25 lbs

• Obese (Pre-pregnancy BMI ≥ 30): 11 to 20 lbs

• Underweight: 28 to 40 lbs

Fetal Heartbeat Detection

• Hear fetal heartbeat: At 12 weeks gestation

Nagel's Rule

• Purpose: Used to estimate due date

Signs of Pregnancy

• Presumptive Signs of Pregnancy:

  • Amenorrhea (absence of menstruation)

  • Fatigue

  • Breast tenderness and pigmentation changes

  • Frequent urination

  • Quickening (maternal perception of fetal movement)

  • Morning sickness (nausea and vomiting)

• Probable Signs of Pregnancy:

  • Positive hCG test

  • Rebound tenderness

PKU Management

• Dietary Recommendation for Maternal PKU:

  • Avoid high protein foods

  • Specific exclusions: dairy (milk, cheese), eggs, meat, peanut butter

Changes in Second Trimester

• Physical Changes:

  • Lordosis (sway back posture)

  • Decreased abdominal muscle tone due to altered center of gravity

  • Increased mobility of pelvic joints due to relaxation of ligaments

Gravida-Para Terminology

• Gravida: Total number of pregnancies

• Term (T): Deliveries after 37 weeks gestation

• Preterm (P): Deliveries between 20 and 36 weeks gestation

• Living Children (L): Number of currently living children

• Multiple pregnancies: Counted as one in gravida, but included in living children count if applicable

Teratogen Definition

• Teratogen: Any agent that can cause birth defects

  • Example Teratogens: Ibuprofen, alcohol, certain infections

Medication Guidelines in Pregnancy

• Disallowed Medications:

  • Ibuprofen, Prednisone (certain conditions apply)

• Caffeine Recommendation: Limit to 200 mg per day

Vaccination During Pregnancy

• Recommended Vaccines:

  • TDAP: Administered at 20 weeks

  • Influenza: Can be given as early as the first trimester

  • MMR: Administered after delivery if not immune to rubella

Vaginal Discharge in Pregnancy

• Normal Discharge: White mucoid discharge

• Abnormal Signs:

  • Thick, cheesy discharge

  • Foul odor

Supine Hypotension

• Definition: Symptoms caused by pressure on the vena cava when supine

• Signs: Fatigue, lightheadedness, potential pain

• Recommendations:

  • Advise patient to lay on their left side to alleviate symptoms

Common Symptoms During Pregnancy

• Heartburn Management:

  • Eat frequent small meals

  • Avoid lying down immediately after meals

  • Avoid spicy foods

  • Encourage respiratory exercises (deep breathing) to improve oxygenation

• Nosebleed Advice:

  • Maintain hydration

Reporting Symptoms

• When to Report:

  • Edema above knees

  • Bleeding during pregnancy

  • Abdominal pain during pregnancy