ESTIMATED DATE OF CONFINEMENT

(EDC)
NAEGELE’S RULE
– count back 3 months from the first day of LMP and add seven and
one year (-3+7+1).
ULTRASONOGRAPHY
– estimates fetal age from head measurements.
FUNDAL HEIGHT
– measurement of fundal height from the top of symphis pubis to the
top of the fundus with a flexible, non-stretchable tape measure;
used as a gross estimate of dates.
 Above the level of symphysis – bet. 12 – 14 weeks
 At the umbilicus or 20 cm – about 20 wks.
 Rises about 1 cm/week until 36, after which it varies.

QKCC 1
FUNDAL MEASUREMENT

QKCC 2
FUNDAL
HEIGHT

QKCC 3
Teratogens in
pregnancy

QKCC 4
QKCC 5
 What is TERATOGENS?
Any agent that can disturb the development of an embryo
or fetus. Teratogens may cause a birth defect in the child.

teratogen may halt the pregnancy outright

teratogens include radiation, maternal infections, chemicals,

and drugs

any substance, organism, or process that causes

malformations in a fetuS

QKCC 6
 TORCH

T OOXOPLASMOSIS

O THER: GONORRHEA, HEP.B, VZV,SYPHILLISO

R UBELLAO

C CYTOMEGALOVIRUS

H ERPES SIMPLEx VIRUS

QKCC 7
 parasitic disease caused by the protozoan Toxoplasma gondii

he parasite spreads by the ingestion of infected meat or the

feces of an infected cat
•There may be no symptoms.
•Symptoms usually occur about 1 to 2 weeks after you come in
contact with the parasite.
•The disease can affect the brain, lung, heart, eyes, or liver.

Headache, sore throat, Fever, Muscle pain, enlarged lymph nodes

Those without symptoms typically do not need treatment.

Medications to treat the infection include an antimalarial drug and
QKCC 8
antibiotics.
QKCC 9
 Other ( GONORRHEA )

Caused by Neisseria gonorrhea

Opthalmia neonatorum

Eye prophylaxis ( erythromycin ointment )

QKCC 10
opthalmia neonatorum

QKCC 11
 Others ( SYPHILIS )

Treponema pallidum

Affects—liver, kidney, adrenal glands

Copper colored maculopapular dermal rash appears

in untreated NBs

Rash appears on---palms of hand, soles of foot,

diaper area, around mouth & anus
QKCC 12
QKCC 13
QKCC 14
 Care management ( syphilis )

• 10 day course of penicillin G

( consult )
• Erythromycin is the substitute
antibiotic

QKCC 15
 Other—Varicella Zoster
• Caused by VZV( Varicella Zoster Virus)
• Eye abnormalities
• IUGR- intrauterine growth restrictions

QKCC 16
 rubella

Mother---mild rash

Teratogenic effect---deafness, cataracts, mental/motor

challenges

QKCC 17
CYTOMEGALOVIRUS (CMV)
•member of the virus family

Droplet infection

Fetus is neurologically challenged

Hydrocephalus, microcephaly, spasticity

Deafness, eye damage, chronic liver disease

QKCC 18
 CYTOMEGALOVIRUS (CMV)
Child skin--
Blueberry muffin ( covered with large petechiae )

Dx—blood serum

No treatment/vaccine

Routine screening for CMV during pregnancy is not

recommended

Handwashing before eating, avoid crowds

QKCC 19
QKCC 20
 Herpes Simplex
( genital herpes infection )

Virus spread through the blood stream

1st trimester:
Severe congenital anomalies, spontaneous miscarriage

2nd/3rd trimester:
Premature birth, IUGR, continuing infection

Fetus may contact the virus from direct exposure when genital
lesion present at time of birth

Woman with history of genital herpes----CS

QKCC 21
genital herpes infection

QKCC 22
 Herpes Simplex
( genital herpes infection )

IV/ oral Acyclovir ( Zovirax ) can be administered

Safe sex is important

QKCC 23
Potentially Teratogenic Vaccine
Live virus vaccine ( mumps, measles, rubella,
poliomyelitis )

Live virus vaccine are contraindicated during

pregnancy

May transmit viral infection to a fetus

QKCC 24
 Teratogenic drugs
Any drug/herbal supplements maybe detrimental to
fetal welfare
Pregnant mother should not take any drug or
supplement not specifically prescribed

Drugs should be approved by MD, RN,RM

Pregnancy risk categories of drugs

QKCC 25
 Teratogenicity of ROH
Congenital deformities
Cognitive impairment

FEATAL ALCOHOL SYNDROME

- Small for gestational age, cognitively challenged

- Short palpebral fissure, thin upper lip, upturned nose

QKCC 26
FAS

QKCC 27
QKCC 28
 Teratogenicity of Cigarettes

Smoking is associated with infertility in woman

Risk for SID syndrome

Low birth weight—vaso constriction of uterine vessels

Secondary smoking, inhaled carbon monoxide

QKCC 29
Metal and chemical hazards

Pesticides, carbon monoxide

Arsenic—by product of copper, lead

Formaldehyde, Hg

QKCC 30
 Radiation
Rapidly growing cells are extremely vulnerable to
destruction by radiation
Range of malformation –depending on the stage of
development of the embryo or fetus

Before implantation---fetus is killed

6 weeks after conception ---most damaging

PT is done before dx test involving x-ray

QKCC 31
 Hyperthermia/hypothermia
Hyperthermia
Interferes with cell metabolism

Saunas, hot tubs, tanning beds, work environment

Hot tubs----40 degrees Celcius, not >10 minutes

Maternal fever
-4-6 weeks causes abnormal fetal brain development, seizure
disorders, hypotonia,skeletal deformities

Hypothermia
Not well known
QKCC 32
 Teratogenic Maternal Stress

Myths, effects of being frightened or surprised while

pregnant

Maternal stress is severe---counselling

QKCC 33
QKCC 34