Reassure parents check the babies abdomen and make

- 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 health
Pregnancy
Signs 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
- htn in 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
- dm in pregnancy
- screen at 24-28 weeks – non fasting 2hr oral glucose tolerance test
- Pregnancy Meds
YES - 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 height should 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 umbilicus
Wt gain – 25-30lbs. obese 20lbs. if under wt. = ideal wt + 25-30lbs
Pregnancy 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 infection treatments 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.