Email this sample to a friend


2

CHAPTER 13

OBSTETRICS


Pregnancy


In women with regular menstrual cycles, a history of one or more missed cycles (periods) is suggestive of pregnancy. Associated symptoms include fatigue, nausea/vomiting, breast tenderness, frequent urination (caused by the enlarged uterus compressing the bladder), and “quickening” (first movements of a fetus felt in utero at 16-20 weeks). Calculate the EDC (estimated date of confinement) by adding 7 days to the first day of the last normal menses and subtracting 3 months.


Signs

Spider angiomata (branched capillaries on the skin, shaped like a spider) and blotchy or patchy palmar erythema (more than 50-60% of patients), regress after delivery.

Striae gravidarum (stretch marks) develop in 50% of pregnant woman.

Hyperpigmentation of nipples, areola, umbilicus, axillae, perineum and midline of lower abdomen (linea nigra). Breast enlargement due to increased hormone levels, which later causes release of colostrum (thin, yellowish fluid seeping from the nipple) and lactation.

Other common signs and symptoms include lightheadedness, backache, dyspnea, urinary symptoms (frequency, urgency, and incontinence), hemorrhoids, heartburn, ankle swelling, varicose veins, abdominal cramping and constipation.

Fetal heart tones can be heard via auscultation (bell side of stethoscope) at or beyond

18-20 weeks of gestation.

Pregnancy tests can be used in the field. Most are nearly as accurate (97-99%) as a laboratory test on serum.

Previous Page Next Page Page 1 of 351