1: Patient Care
5 Topics
2: Normal Obstetrics
7 Topics
3: Abnormal Obstetrics
13 Topics
4: General Gynecology
8 Topics
7: Neoplasia
6 Topics
Antepartum Care
Duration = 8:37
00:00
APGO educational topic number ten
00:02
antepartum care antepartum care refers
00:05
to care before labor and delivery and
00:06
begins with the first prenatal visit
00:08
women who receive antepartum care during
00:11
the first trimester have better
00:12
pregnancy outcomes meet our patient
00:15
newly preggers in this video we will
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follow newly’s journey through
00:19
antepartum care the objectives of this
00:21
video are to diagnose pregnancy to
00:24
assess risk factors for pregnancy
00:25
complications including screening for
00:27
intimate partner violence to describe
00:29
appropriate diagnostic studies and their
00:31
timing for normal pregnancy to list the
00:33
nutritional needs of pregnant women and
00:35
to identify adverse effects of drugs and
00:37
the environment on pregnancy to perform
00:40
a physical examination on an obstetric
00:42
patient to discuss answers to commonly
00:44
asked questions concerning pregnancy
00:45
labor and delivery to describe
00:48
approaches to assess in the following
00:49
fetal wellbeing fetal growth amniotic
00:51
fluid volume fetal lung maturity and to
00:54
describe the impact of pregnancy on
00:55
medical problems and the impact of
00:57
medical problems on pregnancy newly has
01:00
regular 28-day cycles and she has just
01:02
missed a period most women will take a
01:04
home pregnancy test how sensitive is a
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home pregnancy test it becomes positive
01:09
with a beta HCG as low as 25 newly may
01:12
notice symptoms such as fatigue nausea
01:14
vomiting and breast tenderness early in
01:16
pregnancy for low-risk women the first
01:19
prenatal visit will be an intake visit
01:21
at six to eight weeks followed by her
01:23
first prenatal visit before twelve weeks
01:25
what are the goals of prenatal care
01:27
early and continuing risk assessment
01:30
health promotion medical and
01:34
psychosocial intervention and follow-up
01:37
at the time of newly’s first prenatal
01:39
visit a comprehensive history will be
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performed special attention will be paid
01:43
to chronic medical issues past
01:46
pregnancies and their outcomes
01:47
gynecologic issues genetic screening
01:50
issues and social history smoking during
01:53
pregnancy has well-known risks including
01:55
miscarriage placental abruption fetal
01:57
growth restriction preterm delivery
01:59
birth defects and sudden infant death
02:01
syndrome alcohol is a known teratogen
02:04
alcohol consumption during pregnancy is
02:06
a leading preventable cause of mental
02:08
retardation developmental delay and
02:10
birth defects in the fetus other
02:12
important issues
02:13
discuss our drugs environmental and
02:15
health hazards domestic violence which
02:17
occurs with high prevalence during
02:18
pregnancy and seatbelt use one of the
02:21
most important aspects of the first
02:23
prenatal visit is establishment of the
02:25
estimated date of delivery remember that
02:27
we use gestational age that starts on
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the first day of her last menstrual
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period the estimated date of delivery or
02:32
EDD is calculated as 40 weeks past the
02:35
LMP if she has regular 28-day cycles
02:38
vaginal ultrasound can be used to
02:40
determine the EDD if the patient cycles
02:43
are irregular or to confirm the EDD if
02:45
the patient cycles are regular since
02:48
newly is a normal low-risk pregnancy she
02:50
will be seen at four week intervals
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until 28 weeks than every two weeks
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until 36 weeks than every week until
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delivery during each of these visits she
02:59
will have a weight blood pressure and
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fetal assessment for diabetes screening
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there will be a one-hour glucose
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tolerance test between 24 and 28 weeks
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to screen for gestational diabetes for
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obese women the diabetes screening
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should occur at the initial prenatal
03:15
visit how do we monitor the fetus during
03:17
newly’s pregnancy fetal heart rate can
03:20
be verified with a Doppler device
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starting in about 12 weeks chromosomal
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screening provides the probability of
03:26
chromosomal abnormalities the first
03:29
trimester screen provides the
03:30
probability of trisomy 21 and tries to
03:33
be 18 it is performed between 10 and 13
03:35
weeks it is an ultrasound assessment of
03:37
the nuchal translucency and a maternal
03:40
serum test of PAP a and free beta HCG
03:43
alternatively maternal serum screening
03:46
also provides probabilities of
03:47
chromosomal abnormalities
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this is performed between 15 and 20
03:50
weeks the triple test consists of
03:53
alpha-fetoprotein s3l HCG and the quad
03:56
test consists of alpha-fetoprotein stl
03:59
HCG and inhibin the fetal survey
04:02
ultrasound is performed between
04:03
approximately 18 to 20 weeks if we are
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especially concerned about the fetus for
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conditions such as maternal diabetes
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hypertension or fetal growth restriction
04:12
then we will monitor the fetus more
04:14
closely with non-stress test the
04:17
non-stress test measures fetal heart
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rate patterns and accelerations by an
04:20
external transducer for at least 20
04:22
minutes it is considered reactive if
04:24
there are at least two accelerations
04:26
over the twin
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minute period maternal kick counts are
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away for newly to reassure herself of
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fetal well-being starting at around
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thirty two weeks if she is concerned
04:35
about decreased fetal movement then she
04:37
should lay on her side and she should
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feel five movements in one hour or ten
04:40
movements in two hours let’s now move to
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fetal growth the most commonly used
04:45
assessment of growth is fundal height
04:47
measurement this measures the distance
04:49
from the pubic symphysis to the top of
04:51
the fundus the fundal height measurement
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is approximately the number of weeks
04:54
gestation amniotic fluid volume is
04:57
assessed with an amniotic fluid index
04:59
this is a four quadrant assessment of
05:01
amniotic fluid pockets decreased
05:03
amniotic fluid is secondary to the fetus
05:05
shunting blood away from the kidneys to
05:07
the brain which leads to decreased urine
05:09
output let’s now talk about fetal lung
05:12
maturity the respiratory system is the
05:15
last fetal system to mature functionally
05:17
and if newly has to be delivered preterm
05:18
then it can be sometimes helpful to
05:21
assess fetal lung maturity this is done
05:23
by sampling her amniotic fluid through
05:25
an amniocentesis procedure and checking
05:27
for markers of lung maturity what our
05:30
new Lee’s unique nutritional needs
05:32
during pregnancy for folic acid she
05:35
should take at least 0.4 milligrams of
05:37
folic acid daily starting around the
05:39
time of conception and this
05:40
significantly reduces the risk of neural
05:42
tube defects if she’s had a pregnancy
05:44
affected by a neural tube defect and she
05:46
should take four grams of folic acid
05:48
daily excessive weight gain during
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pregnancy leads to an increased risk of
05:52
pregnancy complications such as fetal
05:54
macrosomia it significantly also
05:56
increases the risk of postpartum obesity
05:58
weight gain recommendations are based on
06:01
pre pregnancy BMI for a pre pregnancy
06:04
BMI less than 19 point eight the weight
06:06
gain recommendation is 28 to 40 pounds
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for nineteen point eight to twenty six
06:10
recommended is 25 to 35 pounds for 26 to
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29 it is 15 to 25 pounds and if the pre
06:17
pregnancy BMI is greater than 29 pounds
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the recommended weight gain is 11 to 20
06:21
pounds alternatively inadequate weight
06:24
gain in pregnancy is associated with
06:26
preterm delivery intrauterine growth
06:28
restriction and low birth weight
06:30
there are also foods with specific risks
06:33
during pregnancy unpasteurized milk and
06:35
dairy products and cold lunch meats
06:37
could potentially carry listeriosis
06:38
which causes an increased risk of
06:40
and fetal demise fish is a great source
06:43
of omega-3 oils however large fish such
06:45
as tuna shark and king mackerel have a
06:48
higher mercury content because they eat
06:50
the smaller fish and should be avoided
06:52
during pregnancy herbal remedies are not
06:55
regulated and therefore pregnant women
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should be counseled to consider avoiding
06:58
them
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moving on to frequently asked questions
07:01
can newly exercised during pregnancy yes
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she should avoid exercises that carry
07:06
risks of falling or abdominal trauma and
07:08
she probably shouldn’t start any new
07:10
strenuous exercises during pregnancy
07:12
that she did not partake in pre
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pregnancy can newly have sex yes unless
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she is conditions such as placenta
07:19
previa or premature rupture of membranes
07:21
she and her partner will likely need to
07:23
work together to find positions that are
07:25
more comfortable during pregnancy can
07:27
newly travel yes most airlines allow
07:30
travel up to 36 weeks have her avoid
07:33
long periods of prolonged sitting and
07:34
have her walk every one to two hours to
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promote circulation remind newly of the
07:39
importance of seat belts worn low on her
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hip bones should newly expose yourself
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to teratogen during pregnancy no there
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are very few medications that are proven
07:48
human traditions common ones to avoid
07:50
our East inhibitors coumadin and
07:52
isotretinoin for ionizing radiation it
07:55
is recommended to limit exposure the
07:57
fetus to less than five rads a CT scan
08:00
of the abdomen and pelvis has
08:01
approximately 3.5 rads a CT scan of the
08:04
head is approximately less than 1 rad an
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abdominal x-ray is 100 to 200 milli rads
08:09
and a chest x-ray is 0.02 to 0.075 it
08:14
during newly’s journey 3 antepartum care
08:16
we have discussed pregnancy specific
08:18
needs and considerations and ways of
08:20
assessing fetal well-being and address
08:22
frequently asked questions