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Heart develops week 4 can be heard week 12

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Effects of pregnancy
Breathing abdominal to thoracic
Veins visible breasts.
Blood volume up 40-50%
Uterus puts pressure on diaphragm and bladder
Increase in vaginal secretions
Total Erythrocyte volume increases
Anemia caused by raising in volume, but non blood volume raises more.
Platelet and plasma fibrinogen increases
Increased clotting factor.
N/V
Connective tissues, Pelvic joints loosed, waddling.
Gain up to 5 pounds first trimester, then one pound after.
Higher iron demand, higher fat absorption
Prolactin lactation
Oxytocin, Higher Contractions.
PRESUMPTIVE (subjective): Amenorrhea, N/V, Excessive Fatigue, Breast Changes,
Quickening.
PROBABLE(objective): Changes in pelvic organs, enlarged abdomen, Braxton hicks,
abdominal striae, uterine souffl, changes in skin pigment, ballottement, positive
pregnancy test(test for hCG)
Definitive: Hear fetal heart, See fetal movement, See fetus. HEAR OR SEE

13:
GPAL GTPAL
EDB is EDB is EDD birth confinement delivery
LMP if none, ultrasound
Screens: pap smears, cbcs, hiv, rubella, ABO, Rh, urine, HepB, STI,
GDM(diabetes), Hgb, Htc, GBS(group b strep), PPD,
Quad test (down, turner, trisomys)
DANGER SIGNS: gush of fluid, vaginal bleed, abdominal pain, fever, dizzy, visual
impairment, persisten vomiting, severe headache
Pre term labor signs, normal signs of pregnancy but early cramp pressure, pain,
contrations every 10 minutes in hour. Water leakage.
Every month until week 28, then every 2 weeks until week 36 then every week.
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Teratogenic
Tobacco
Fetal Alcoholm Syndrome
Affects fetus within minutes
Older mothers all problems.
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Folic acid needs reduction of neural tube defects
Iron demand up
Early the worse. Permanent if early in cell division
PICA eat weird shit
Increase protein intake, up calcium intake
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5.1 to 5.9 percecnt of moms, substance abuse, legal or illegal

ALCOHOL USE: malnutrition, liver disease for MOM fetal alcohol spectrum disorder
(FASD)
Thin upper lip, small eye openins, growth and neural deficiencies.
COCAINE: MOM: Seizure, hallucinations, lung edema, respiratory failure, cardiac
problems, abruption placentae, IUGR, preterm, stillbirth
FETAL: Decreased birth weight, decreased head, feeding difficulties,
irritability, vomit, Apnea,
MDMA: impaired memory learning
HEROIN: MATERNAL: malnutrition, low iron, pre eclampsia, placenta previa,
abruptio, preterm labor, meconium staining, STDS HIV up
FETAL: Breech, IUGR, withdrawal after birth
Moms with DIABETUS
MATERNAL: hydramnios, pre eclampsia, hyperglycemia, ketoacidosis, dystocia, Up
for infections and retinopathy
FETAL: Macrosomia, Hypoglycemia, IUGR, perinatal mortality, rds, respire distress
syndrome, hyperbilirubinemia, hypocalcemia.
Screen 24 to 28 weeks unless high risk.
Oral glucose tolerance test: fast blood sample is drawn, patient drinks solution high in glucose, then
blood is drawn at intervals after. Patient must fast morning of test
Fasting: 115 1 hour: 200 2 hour: 175 3 hour: 135
Glucose challenge test 24 weeks. 1 hour after oral glucose load, over 130 bad.
NST 28 weeks
Ultrasound 18 28 weeks
ANEMIA: less then 11 IRON to fix more then 1000mg a day, longer in preg, more needed.
MATERNAL COMP: Up for infection up for fatigue up for slow healing up for bleeding and preeclamp
FETAL: Low birth weight, prematurity, stillbirth, death.
FOLIC ACID DEFIC ANEMIA: Neural Tube defects NTD,
HEART DISEASE: class 1 2 3 4 escelates in danger

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Bleeding during pregnancy bad
Bp IV weigh bleeding, FHR if viable
RH needed? Rhogam
Causes of bleed.
All pregnancy before 20 weeks, are abortions
Threatened, Imminent, Incomplete, Complete, Missed, Septic Abortion
Recurrent pregnancy loss
Will happen if bleeding occurs under placenta
Ectopic pregnancy
Risks, tubal damage, prev surgery, IUD, High progesterone, endometriosis, smoking,
age,
Pregnancy seems normal, not obv sympt, slow constant internal bleeding
Differentiate from others with ultrasound, sX
GESTATION Trophoblastic Disease:tumor elevated hCG low MSAFP Hyperemesis,
preeclampsia,
Ultrasound diagnosis
Treatment is suction evacuation curettage (for both above)
Follow up to confirm no spread.
Hyperemesis correct symptoms, restore effects, electrolytes
Hypertensive: chronic hyper, preeclamp, eclamp, gestational
PREECLAMPSIA
Risk everyone
Elevated hypertension
HELLP syndrome

Hemolysis, Elevated Liver enzymes, low platelet count, associated with severe
preeclampsia,
After 20 weeks 140 over 90 protein edema, sever preclamp 160 110 proteinuria,
oliguria
Cure is delivery
Aspirin, Diet,
Mild monitoring,
Severe, Hospitilization
Deep tendon reflex high associated non abnormal
Seizure moves from pre to eclampsia
Treat with antihypertensive, magsulfate
RH given to any exposure of baby blood to mother. 28 weeks to all negative
Correct anemia in infant
ABO incompatibility no treatment, mild anemia
Toxoplasmosis
Cat feces severe damage susceptible as you get later
Rubella
Prevention, test all, if infected 1st tri abortion
Herpes Simplex
Abortion, PTL, IUGR, Lesion, c section
Group B
Maternal morbidity, unexpect stillbirth
Human B Parvo 5th disease, fetal death
ZIKA mosquito
Microhead
No vacc day dangerous
(Ae. aegypti andAe. albopictus) mosquito.

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Terms:
Braxton Hicks contractions
Goodells sign Softening
Chadwicks sign - Bluish purple discoloration
Colostrum
Striae Gravidarum
Lanuga
AVA: two arteries one vein vein carries oxygenated blood.
hCG
Progresteron
Estrogen
Naegels rule: Forward 7 days, Back 3 months, Forward one year from lmp
Meconium
Quickening
Lightening
Hydramnios

OligoHydramnios
Supine hypotensive syndrome
Linea Nigra/Alba
Uterine Souffle
Ballottement
Mcdonalds method
HP2020s
Nonstress testing
Biophysical Profile
Ultrasound