Transcript Normal Pregnancy - Operational Medicine

Normal Pregnancy
CAPT Mike Hughey, MC, USNR
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 1
Symptoms of Pregnancy
• Nausea (1st TM)
• Breast and nipple tenderness (1st
TM)
• Marked fatigue (1st & 3rd TM)
• Urinary frequency (1st & 3rd
TM)
• Patient thinks she’s pregnant
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 2
Pregnancy Tests are Very Reliable
• Turn positive at about the first
missed period (4 weeks after
the LMP or 14 days after
conception.
• Detect ~30 units of HCG
• Double the sensitivity by
doubling the amount of urine.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 3
Serum can be Used
• May use serum if urine is unavailable
• Tape red-top tube to the wall
• After 10 minutes, draw off enough serum
to match, drop for drop, the urine required
for the test.
• Sludging of proteins, albumin can be a
problem
• Different forms of HCG in urine and serum
• Will work well enough for most purposes.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 4
Routine Visits
•
Q4 weeks until 28 weeks
•
Q2 weeks, 28-36 weeks
•
Q week, 36-delivery
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 5
Routine Visits
• At each visit:
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 6
Urine Test for Protein and Glucose
• Protein may indicate preeclampsia
• Glucose may indicate
gestational diabetes
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 7
Estimating Gestational Age
• LMP plus 280 days
• Add 7 days, subtract 3
months
• MacDonald's Rule
(cm = weeks)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 8
Fetal heart beat
• You may never hear it
with a stethoscope
• 16-20 weeks with
DeLee Stethoscope
• 12-14 weeks with
Doppler
• 5-6 weeks with
ultrasound
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 9
Take a Prenatal Vitamin Each Day
•
Folic Acid 400 mg/day
before pregnancy
•
600-800 mg/day during
pregnancy
•
Those with a normal
balanced diet probably
don’t need extra vitamins
•
No one has a normal
balanced diet.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 10
Initial Prenatal Laboratory Tests
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Hgb/Hct
WBC
U/A
Blood type & rH
Atypical antibody screen
Rubella titer
RPR or VDRL
Hep B
HIV
GC/Chlamydia
Pap
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 11
Subsequent Laboratory Tests
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Amniocentesis at 11-17 weeks
for women >35
Serum AFP at 15-18 weeks
Targeted (Level II) ultrasound
for women at high risk at 1620 weeks
Hgb/Hct at 28 weeks
OB Glucose at 28 weeks (1hour post 50 g oral load)
Rhogam to all rH negative
women at 28 weeks
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 12
Skin Changes
• Chloasma (darkening of face)
• Spider telangectasias (red, starshaped marks)
• Stretch marks
• Linea nigra
• Darkening of nipples
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 13
Exercise During Pregnancy
• Balance
• Joint changes
• Heat
• Increased cardiac output
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 14
Nausea & Vomiting
• Common up to 16 weeks
• If she can’t keep anything down, or
has ketones in urine, give IV fluids
• Avoid antiemetics
• Benadryl, Scopolomine,
Compazine, Phenergan,
Reglan have all been used with
good results
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 15
Heartburn
• Reflux esophagitis
• Antacids are OK
• Suck on them rather
than chewing them
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 16
Sciatica
• 30% of pregnancies
• Avoid standing for
long periods
• Sit with knees slightly
higher than the hips
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 17
Sciatica
• Sleep in semi-fetal position
with a pillow between the knees
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 18
Carpal Tunnel Syndrome
• 30% of pregnancies
• Numbness of the distal median nerve due to
compression from edema
• Worse in the morning
• No treatment necessary so long as lesion is
sensory only
• Rest, wrist splint may be helpful
• Injections, surgery almost never necessary
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 19
Upper Respiratory Infection
• Acetaminaphen - OK
• Guaifenisin - OK
• Pseudoephedrine - OK in 2nd
TM
• Triprolidine - OK
• Penicillins - OK
• Cephalosporins - OK
• Erythromycin - OK
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 20
Medications During Pregnancy
• Antibiotics - some OK, some not
• Local anesthetics - OK
• Local with epinephrine - not OK
• Aspirin - not OK
• Immunizations - some are OK, some
are not
• Antimalarial - some OK, some are not
• Narcotics - OK except for addiction
issue
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 21
Thermal Stress During Pregnancy
• Avoid elevation of core
temperature
• Mess decks
• Engine room spaces
• Laundry
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 22
Acoustic Stress During Pregnancy
• Fetus receives about 15 dBA less than the
mother.
• Avoid exposure in which ear protection is
needed.
• Brief transit is OK (less than 5 minutes)
• If double ear protection required,
pregnant woman should avoid the area
completely.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 23
Low Frequency Whole Body Vibration
•
Avoid it if possible
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 24
Chemical Exposure During Pregnancy
Avoid:
• Organic solvents
• Fuel oils
• Paint thinners
• Mercury
• Lead
• Cadmium
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 25
Radiation Exposure During Pregnancy
• Avoid radiation exposure
• If it's important, then go
ahead but shield the
abdomen to the extent
possible.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 26
Diving During Pregnancy
• Don't do it
• Pregnant are women predisposed to
decompression sickness and
embolism.
• Fetal circulation bypasses the
lungs...any bubble goes directly to
the brain or coronary arteries.
• Prolonged low hyperbaric pressures
may be safe, but fetal effects
include narrowing of foramen ovale
and ductus arteriosus
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 27
Aircrew Status
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G forces
Noise
Heat
Balance
Fumes
Rules vary by
service, type of
aircraft, job, and
mission
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 28
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 29