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Types of Pelvis

  • Gyneproic Pelvis (Gynecoid):
    • Wider at the top and pelvic outlet.
    • Generally favored for vaginal delivery due to greater space for the baby to pass through.
  • Anthropoid Pelvis:
    • Narrower structure generally seen in men.
    • Can lead to difficulties in vaginal delivery depending on baby size.
    • May necessitate a C-section if the baby does not fit through the birth canal.

Importance of Pelvic Structure

  • Crucial for ensuring enough room for the baby to pass down during labor.
  • Soft tissues around the coccyx can provide additional space during contractions.
  • Health practitioners must be aware of pelvic structures to manage vaginal deliveries safely.

Prenatal Care Schedule

  • Pregnancy Visits:
    • 0 - 28 weeks: Every 4 weeks.
    • 29 - 36 weeks: Every 2 weeks.
    • After 36 weeks: Weekly visits.
  • Importance of prenatal visits for monitored health of both mother and baby.

Fetal Viability and Pregnancy Terminology

  • Viability: Generally considered to be 20 weeks gestation.
  • Fetuses under 20 weeks cannot survive outside the uterus; labor and delivery protocols differ as no attempts to save fetus will be made in cases of complications.
  • Abortion: Defined as delivery prior to 20 weeks, whether spontaneous (miscarriage) or induced.

Pregnancy Trimesters

  • Divided into three trimesters, about 13 weeks each.
  • First Trimester: Initial confirmation of pregnancy through urine/blood tests that detect human chorionic gonadotropin (HCG) hormone.

Initial Health Assessments

  • Blood tests done to assess health and presence of infections:
    • CBC: Evaluate hemoglobin, hematocrit, WBC count for infection.
    • Syphilis Testing: Legally required (VDRL or RPR).
    • Chlamydia & Gonorrhea Swabs: Assessed to prevent complications during delivery.
  • TORCH Panel: Checks for harmful viral infections (i.e., Rubella, Hepatitis B, HIV, Toxoplasmosis).

Nutritional Needs in Pregnancy

  • Essential daily nutrients include:
    • Protein: 60 grams per day for development.
    • Calcium: 1200 mg per day for bones and fetal needs.
    • Iron: 30 mg to develop fetal iron stores.
    • Folic Acid: 0.4 mg daily (begins 3-6 months pre-pregnancy) to minimize neural tube defects.

Common Pregnancy Symptoms

Presumptive Signs:
  • Amenorrhea, nausea, breast tenderness (not definitive).
Probable Signs:
  • Giddells, Chadwick's, Hagar's, McDonald's, Braxton Hicks (observed but not confirmed).
Positive Signs:
  • Fetal heartbeat (110-160 bpm), fetal movement by examiner, ultrasound visualization.

Physiologic Changes During Pregnancy

  • Increased blood volume by 45-50% by the second trimester.
  • Blood perfused to the uterus critical for oxygen, nutrients, and passive immunity transfer to the fetus.
  • Caution regarding positioning to avoid compressing vena cava, which can decrease blood flow and oxygen availability.

Testing for Conditions in Pregnancy

  • Glucose Tolerance Test: Screen for gestational diabetes between 24-28 weeks.
  • Serum alpha-fetoprotein test: Identifies possible neural tube defects or chromosomal issues.
  • Ultrasound at 16 weeks: Monitors baby growth and detects anomalies.

Group Beta Strep (GBS) Testing

  • Performed after 35 weeks gestation via vaginal and rectal swab to check for bacteria that could infect the baby during delivery.
  • If positive, mothers undergo intravenous antibiotics during labor to prevent neonatal infections.