قسم النساء والتوليدOBSTITRICS &GYNACOLOGY

DEPARTMENTPROBLEM(2)

G(4)

From 6th weeks to12th weeks of pregnancy nausea &vomiting in the early morning is so common that it’s accepted as a symptom of normal pregnancy .

It usually occurs soon after waking and often retching rather than vomiting .It nearly always stop before the 14th week and doesn’t disturbe the patient’s health or her pregnancy .Caused by something other than physiological reaction to pregnancy and the increase incidince of vomiting in cases of twins and hydatidform mole has led to the theory that is trophin or of sensitivity to it .

The vomiting occurs at the time of peak out put of this hormone in normal pregnancy ,but studies comparing hormone levels and sensitivities in cases of excessive vomiting with those of normal controls have not consistently supporeted this theory.

The vomiting is persistant and disturbe the patient’s health it is termed Hyperemesis gravidarum .

Starvation and dehydration namely ketosis ,electrolyte imbalance and vitamin deficiency .

Was a significant cause of maternal mortility .

Fatal cases : sever weight loss –achycardia and hypotension – oligouria –neurological disorders from vit B deficiency and jaundice from hepatic necrosis were seen.

In some of the persistant cases there may be psychological factors .

Hyperemesis is almost unknown in so-called under-developed countries

Treated by reassurance and some times by giving one of the antiemetic .

E.g : meclozine 25mg ,cyclizine 50mg or promezthine 25mg. Up to 3 times daily.

If the vomiting is sever the patient is admitted to hospital

If the continues of dehydration ,ketosis and electrolyte imbalance require treatment by I.V fluids and antiemetic and some times with vit supplements

The pregnancy trimester is divided into three stages of three months each. The 40 weeks of gestation thus get divided into smaller, separate and distinct phases of developments for both the mother and the baby.

The first pregnancy trimester is the stage of pregnancy from conception to 12 weeks.

During this stage, mother will have to endure one or more of the following symptoms: tenderness of breasts, tiredness, morning sickness (which can happen any time of the day), headaches, frequent urination, and others.

As the first trimester ends, the size of her uterus resembles that of a grapefruit and the baby inside becomes the size of a cherry.

Now, the baby has heartbeats, reflexes, and can move its tiny limbs.

At this trimester, mother have to be very particular about prenatal care and her nutrition.

In addition to this, she should exercise regularly keeping the safety of her baby in mind.

The second pregnancy trimester starts from the 13th week to the 28th week.

Initial nausea and fatigue abates and the baby grows rapidly and shows movements; the umbilical cord thickens to carry oxygen and nourishment to the fetus.

During this stage of pregnancy, there will be growth of hair all over the baby's body in order to regulate her body temperature after birth.

As second trimester ends, the baby will be about 10 inches (25 cm) long and start her kicking movements.

Light exercise, good personal hygiene, nutritive diet adds to the healthy growth of the baby at this stage.

The second pregnancy trimester starts from the 13th week to the 28th week.

Initial nausea and fatigue abates and the baby grows rapidly and shows movements; the umbilical cord thickens to carry oxygen and nourishment to the fetus.

During this stage of pregnancy, there will be growth of hair all over the baby's body in order to regulate her body temperature after birth.

As second trimester ends, the baby will be about 10 inches (25 cm) long and start her kicking movements.

Light exercise, good personal hygiene, nutritive diet adds to the healthy growth of the baby at this stage.

This is the last trimester from the 28th week till the birth of the baby.

The fetus continues to grow in size, bringing in changes in physical appearance.

All the organs of the baby are developed, except the lungs, which continue to develop until the end of this trimester .

Now, the mother and her baby are waiting for the due date to arrive! .

- To prevent, detect, and manage those factors that adversely affect the health of mother and

baby.

-To provide advice, reassurance, education, and support for woman and her family.

-To deal with minor aliments. (Nausea, heartburn, constipation, shortness of breathing, dizziness, swelling, backache, abdominal discomfort, head

ach).

-To provide general health screening.

-The booking visit:-

-The degree of visit of pregnancy determined by repeated (history taking, physical examination, and investigation).

-Symptoms: (breast tenderness, nausea, amenorrhea, urinary frequency).

-urinary or serum test is positive.

- To determinate expected day of delivery EDD.

-Menstrual EDD: - by Naegeles rule.

-Dating by ultra sound U/S: - before 15-16 weeks by CRL – BPD.-

1- Post medical history:-

-Interaction between pregnancy and medical, surgical, and psychiatrics condition given (maternal medicine).

-Diseases and treatment (teratogenic).

2-Post obstetrics history:- -pregnancy complication, previous labours, and

deliveries.

3-Previous gynecological history:-

-history of infertility or recurrent miscarriage (fetal growth restriction, pre-eclampsia, and fetal chromosomal abnormality).

-gynecological surgery (myomectomy may weaken the uterus lead to uterine rupture during labour).

4-Family history:- -gestational diabetes common in family

with type2 DM. -thromboembolic disease lead to deep

veins thrombosis and pulmonary emboli. 5- Social history:- -smoking and alcohol misuse. *age and radical origin.

-full physical exam (cardiovascular, respiratory system, abdominal, full pelvic, and breast exam).

-heart sound murmurs heard in most pregnant women result from hyper dynamic circulation.

-exam for bleeding and discharge.

-breast exam (pregnancy-related physiological change in breast tissue) .

-accurate measurement of BP .

-abdominal exam to record size of uterus.

-recognition of any abdominal scars indicative of previous surgery.

-measurement of height and weight for calculation of the

baby mass index BMI .

-urine exam:- asymptomatic bacteruria is more likely cause pyelonephritis in pregnancy .

-full blood count . -blood group and red cell antibodies . -rubella . -hepatitis B . -HIV. -syphilis . -hemoglobin studies. -gestational diabetes . -other routine investigations .

-between 11 and 22 weeks include: 1\ nuchal translucency scanning (11 – 13

weeks) or serum screening (15 – 19 weeks) for downs syndrome .

2\ maternal serum alpha-fetoprotein (15 – 19 weeks) for neural tube defects e.g. spinobifida , anencephaly .

3\"detailed" or "anomaly " ultra sound (19 – 22 weeks) for structural congenital abnormalities .