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Pregnancy is protective from PID.

ECTOPIC PREGGERS o CORNERSTONE Dx Quantitative -HCG Discriminatory level: <15 K mIU/ml o TRIAD Vaginal bleeding Abdominal pain amenorrhea o Use Methotrexate if EP < 3.5 cm (-) intra-abdominal hemorrhage 6 weeks AOG If (+) of fetus should be dead o MC RF PID Previous tubal pregnancy IUD Previous tubal surgery MgSO4 has a hygroscopic property that decreases edema. BISHOPS SCORE: >5 SASSONE: 9 Be pregnant o NSD: after 2 years o ABORTION: 3-6 months After pregnancy: EARLIEST o Ovulation: 3 months o Menses: 6 months Uterus: o Size: enlargement due to HPY and HPL o Position: dextrorotated o HEGARS SIGN: 1st Trimester o LAYERS Endometrium Decidua basalis Decidua vera Decidua parietalis Myometrium External, middle, internal Serosa o Contractions: Braxton-Hicks vs. TRUE labor CERVIX

o GOODELLS Sign: 4 weeks o Mucus plug made up of (3) OVARIES o Corpus luteum vs. CL of pregnancy: up to 8 weeks o Luteoma of pregnancy vs. hyperreactio luteinalis SKIN o Striae gravidarum o Diastasis recti o Palmar erythema o Linea nigra, chloasma Assoc. with estrogen not with MSH; 2nd trimester FALLOPIAN TUBES: elongated VAGINA o CHADWICKs SIGN: 6 weeks o Increase pH BREAST o (+) Montgomery tubercles, secondary areola, colostrums Weight gain: 12.5 kg/ 27.5 lbs; Williams: 25-35 lbs, for overweight teenagers: 15 llbs LAYERS OF THE ABDOMINAL WALL o Skin o subQ o Campers o Scarpas o Anterior Rectus o Rectus Abdominis o Posterior rectus o Pre-peritonial fat o Parietal fascia Nausea/vomiting: 2-3 months Disturbance of urination: 2-3 months PROGESTERONE causes: o Increase in body temp o Fatigue and drowsiness ESTROGEN causes: breast tenderness o FERNING o Estrogen is associated with INCREASED NaCl which causes the cervical mucus to fern 16-32 weeks: FU = AOG 28 weeks: B-H 24 weeks: Leopolds Maneuver Pregnancy Test o Serum 8-9 days o Urine: 2-3 weeks after fertilization

HCG: PEAKS at 60th -70th day, plateaus at 100-120th day FETAL HEART TONE o UTZ: 4-5 weekssd o ECG: 6-8 weeks o DOPPLER: 10-12 weeks o Stet: 17-18 weeks Fetal movement: felt by examiner: 20 weeks o Felt by mother N: 16-17 weeks M: 18-19 weeks Lightening: ONLY in primiparas EDC = o Coitus + 266 days o Ovulation 3 months o Naegeles o Quickening + 24 M/22 N weeks Kessler index: measures preconception care Quetelet Index = Body Mass Index CRL = AOG at 12 weeks PRENATAL CARE: every . . . o 4 weeks: 28 weeks AOG o 2 weeks 36 weeks AOG o 1 week END o ADEQUATE: #5 PNCUs LMP: EDC +/- 2 weeks UTZ: EDC +/- 2 days Iron o Started at 16 weeks AOG o Exacerbates nausea and vomiting o Total: 1000 = 300 (baby) + 500 (mother) o (+) maternal dilutional anemia at 2nd trimester Increase by 450 ml of blood (+) 1.1 mg Fe/RBC o At 3rd trimester: increase transport of iron to fetus Folate o Given 1 month before (CPG: 3 months) and at 1st trimester o Needed for - - - WILLIAMS o 0.4 mcg (?) Given 1 month before (CPG: 3 months) and at 1st trimester And if with prior history of neural tube defect PLACENTA o 185 mm (dm) x 23 mm (thickness) o 497 ml in volume o

o o o o BPS o o o o o

508 g COTYLEDON: 10-38 Umbilical cord: 55-60 cm; longest recorded: 300 cm (check na lang) 6:1, ratio or birth weight to placental weight Fetal breathing Fetal tone Fetal movement Amniotic fluid volume Non-stress test Usually done if the score for the first 4 is low If with normal score: MCCOD: Maternal and fetal hemorrhage Umbilical cord accidents Abruption placenta 10/10: normal, 8/10: normal or suspected, 6: possible, 4: probable, 0-2: almost certain

HEMA o Hemoglobin: 11-12.5 mg/dl o WBC: Labor and puerperium: 16-26 K Ultrasound: reliable for EDC until the 20th week AOG LABOR o Regular, painful contractions every 3-5 cm that leads to cervical change ACTIVE LABOR o 3-4 cm with uterine contractions ENGAGEMENT o Descent of BPD below the level of pelvic inlet; lowest point is at the level of the ischial spines; 5 cm: from PELVIC INLET ISCHIAL SPINES FIXATION o Descent through the pelvic inlet to a depth PADAKAR: Uterine height = fundic height 3 (cervix)

Gestational hypertension BP 140/90 mm Hg for first time during pregnancy No proteinuria BP returns to normal < 12 weeks' postpartum Final diagnosis made only postpartum May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia Preeclampsia Minimum criteria BP 140/90 mm Hg after 20 weeks' gestation Proteinuria 300 mg/24 hours or 1+ dipstick Increased certainty of preeclampsia BP 160/110 mg Hg Proteinuria 2.0 g/24 hours or 2+ dipstick Serum creatinine > 1.2 mg/dL unless known to be previously elevated Platelets < 100,000/mm3 Microangiopathic hemolysis (increased LDH) Elevated ALT or AST Persistent headache or other cerebral or visual disturbance Persistent epigastric pain Eclampsia Seizures that cannot be attributed to other causes in a woman with preeclampsia Superimposed Preeclampsia (on chronic hypertension) New-onset proteinuria 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks' gestation A sudden increase in proteinuria or blood pressure or platelet count < 100,000/mm3 in women with hypertension and proteinuria before 20 weeks' gestation Chronic Hypertension BP 140/90 mm Hg before pregnancy or diagnosed before 20 weeks' gestation not attributable to gestational trophoblastic disease OR Hypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks' postpartum