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- frequent crying. Reassure parents. Check the babies abdomen and make sure they are eating/peeing enough. - increased gas? Make sure they are burping the baby Womens healthPregnancySigns of pregnancy- presumptive- amenorrhea, brest tenderness, nausea/vomiting, fatigue, chadwicks sign - probable – things that the MD can detect – enlarged uterus, +HCG- positive - direct evidence of preg. Fetal heart tones, US- htnin pregnancy- treatment - no ace or arbs in pregnancy cat D. organ malformation and/or renal failure to baby-primary HTN is diagnosed before 20 weeks. Other wise >20 = pre eclampsia- dmin pregnancy - screen at 24-28 weeks – non fasting 2hr oral glucose tolerance test- Pregnancy MedsYES- PCN, macrolides- Zithromax, Tylenol, antacids, clindamycin, heparin, Colace NO- ACE/ARBs, Statins, Sulfa, valproic acid, Coumadin, phenytoin, tetracyclines
- vacations and pregnancy and babies - no MMR, varicella or herpes - common heart sound changes in pregnancy– louder s1, split s1, displaced apical pulse, systolic ejection murmur, s3. - Will have an increase in blood volume, increase HR (minimal), increased CO (by 30%), and DECREASED SVR and PVR from hormones-fundal heightshould be equal to weeks gestation after 20 weeks. 34 weeks = 33-35cm -12 weeks – palpable just above the symphysis pubis-20 weeks at the level of the umbilicusWt gain– 25-30lbs. obese 20lbs. if under wt. = ideal wt + 25-30lbsPregnancy hormones-Alpha fetoprotein- produced in the fetal (mostly)and maternal liver. Can be elevated in neural tube defects, low in downs syndrome and fetal demise. Take folic acid - HCG- produced by the placenta- Abortions- threatened – bleeding cramping- closed cervix- inevitable – vaginal bleeding with pain and cervical dilation - incomplete – moderate to diffuse bleeding with the passage of tissue - complete- - flu-meds and inactivated flu vaccine okay in pregnancy – all trimesters. - Preg women have an increased morb. And mortality with the flu - if mom has flu like symptoms within 2 weeks postpartum she needs meds and to be separated from baby. - she can still pump and feed baby, even ill and on meds- STI infectiontreatments and for pregnant women - chlamydia- preg. 1gm azithromycin- postpartum endometritis = broad spectrum antibiotics- poly therapy. - test for cure in all STI pregnant women - those with renal disease who become pregnant- need to be followed closely with their nephrologist and OBGYN- can develop normochromic normocytic anemia - less than expected expansion of plasma volume- increased risk of clots - vit D deficiency - keep bp below 140/90- ASA 75-81mg daily for protection - Preeclampsia- HTN after 20 weeks and 2 BP > 140/90 at least 6hrs apart- risk factors- age >40, age <16, first pregnancy, and multiple gestation - cure is delivery - symptoms – HA, blurred vision, edema of the face and upper extremities, wt gain, proteinuria.