Obs Chapter No 1: Prenatal Management of Normal Pregnancy

Diagnosis of Pregnancy

Presumptive	Unrelated to Uterus or fetus	Amenorrhea
Probable	Related to Uterus or mother	Inc. Uterine size & B-HCG
Definitive	Related to fetus	Sonogram and Heard FHT

Pregnancy Dating

Duration of Pregnancy using	Conceptual dating	266 days or 38 weeks
Duration of Pregnancy using	Menstrual dating	280 days or 40 weeks
Calculate due date	Naegele’s rule	LMP-3 months + 7 days

This two charts you should know in any case.

Basal Body temperature (BBT)

The accuracy of BBT is +/- 1 week

Normal Pregnancy Events

First Trimester

• ·         Assuming a 40 menstrual week pregnancy, First trimester extends from conception to 13^th week
• ·         Morning sickness
• ·         Spotting and bleeding (20% pregnancy)
• ·         Average weight gain 5-8 pound
• ·         Complication: Spontaneous abortion

 Second Trimester

• ·         Assuming a 40 menstrual week pregnancy, 2^nd trimester extend from 13^th to 26^th week
• ·         Braxton-Hicks contraction
• ·         Quickening (materal awareness of fetal movement) by 5^th month. Multi-gravida feels it earlier
• ·         Average weight gain 1 pound per week after 20 weeks
• ·         Complication: Incompetent cervix, premature membrane rupture & premature labor

Third Trimester

• ·         26^th week to 40^th week
• ·         Normal symptoms include back pain, decrease libido, leg pain, increase urinary frequency  & Braxton hicks contraction
• ·         Lightening describes descent of fetal head into the pelvis
• ·         Average weight gain 1 pound per week
• ·         Complication: Premature membrane rupture, preeclampsia, UTI and gestational diabetes
•  Remember complications of each Trimester.

Danger Sign of Pregnancy

Complaint	Possible Diagnosis
Vaginal bleeding	Early (sp. Abortion) Later (abruption, previs)
Vaginal fluid leakage	Membrane rupture and urinary incontinence
Severe epigastric pain	Severe preeclampsia
Uterine Cramping	Preterm labor
Dec fetal movement	Fetal compromise
Headache, visual change	Severe preeclampsia
Chills and fever	Pyelonephritiis

Safe Immunizations During Pregnancy

·         Influenza

·         Hepatitis A & B

·         Pneumoccocus

·         Meningococcus

·         Typhoid