{"id":107,"date":"2020-08-12T19:57:25","date_gmt":"2020-08-12T19:57:25","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=107"},"modified":"2021-05-09T20:34:59","modified_gmt":"2021-05-09T20:34:59","slug":"10-antepartum-care","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/10-antepartum-care\/","title":{"rendered":"10. Antepartum Care"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/JM7oqjqtA8o\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 8:37<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5807191b6052797832' value='69e9b5807191b6052797832'><input type='hidden' id='bg-show-more-text-69e9b5807191b6052797832' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5807191b6052797832' value='Hide Transcript'><button id='bg-showmore-action-69e9b5807191b6052797832' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5807191b6052797832' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number ten<br \/>\n00:02<br \/>\nantepartum care antepartum care refers<br \/>\n00:05<br \/>\nto care before labor and delivery and<br \/>\n00:06<br \/>\nbegins with the first prenatal visit<br \/>\n00:08<br \/>\nwomen who receive antepartum care during<br \/>\n00:11<br \/>\nthe first trimester have better<br \/>\n00:12<br \/>\npregnancy outcomes meet our patient<br \/>\n00:15<br \/>\nnewly preggers in this video we will<br \/>\n00:17<br \/>\nfollow newly&#8217;s journey through<br \/>\n00:19<br \/>\nantepartum care the objectives of this<br \/>\n00:21<br \/>\nvideo are to diagnose pregnancy to<br \/>\n00:24<br \/>\nassess risk factors for pregnancy<br \/>\n00:25<br \/>\ncomplications including screening for<br \/>\n00:27<br \/>\nintimate partner violence to describe<br \/>\n00:29<br \/>\nappropriate diagnostic studies and their<br \/>\n00:31<br \/>\ntiming for normal pregnancy to list the<br \/>\n00:33<br \/>\nnutritional needs of pregnant women and<br \/>\n00:35<br \/>\nto identify adverse effects of drugs and<br \/>\n00:37<br \/>\nthe environment on pregnancy to perform<br \/>\n00:40<br \/>\na physical examination on an obstetric<br \/>\n00:42<br \/>\npatient to discuss answers to commonly<br \/>\n00:44<br \/>\nasked questions concerning pregnancy<br \/>\n00:45<br \/>\nlabor and delivery to describe<br \/>\n00:48<br \/>\napproaches to assess in the following<br \/>\n00:49<br \/>\nfetal wellbeing fetal growth amniotic<br \/>\n00:51<br \/>\nfluid volume fetal lung maturity and to<br \/>\n00:54<br \/>\ndescribe the impact of pregnancy on<br \/>\n00:55<br \/>\nmedical problems and the impact of<br \/>\n00:57<br \/>\nmedical problems on pregnancy newly has<br \/>\n01:00<br \/>\nregular 28-day cycles and she has just<br \/>\n01:02<br \/>\nmissed a period most women will take a<br \/>\n01:04<br \/>\nhome pregnancy test how sensitive is a<br \/>\n01:07<br \/>\nhome pregnancy test it becomes positive<br \/>\n01:09<br \/>\nwith a beta HCG as low as 25 newly may<br \/>\n01:12<br \/>\nnotice symptoms such as fatigue nausea<br \/>\n01:14<br \/>\nvomiting and breast tenderness early in<br \/>\n01:16<br \/>\npregnancy for low-risk women the first<br \/>\n01:19<br \/>\nprenatal visit will be an intake visit<br \/>\n01:21<br \/>\nat six to eight weeks followed by her<br \/>\n01:23<br \/>\nfirst prenatal visit before twelve weeks<br \/>\n01:25<br \/>\nwhat are the goals of prenatal care<br \/>\n01:27<br \/>\nearly and continuing risk assessment<br \/>\n01:30<br \/>\nhealth promotion medical and<br \/>\n01:34<br \/>\npsychosocial intervention and follow-up<br \/>\n01:37<br \/>\nat the time of newly&#8217;s first prenatal<br \/>\n01:39<br \/>\nvisit a comprehensive history will be<br \/>\n01:41<br \/>\nperformed special attention will be paid<br \/>\n01:43<br \/>\nto chronic medical issues past<br \/>\n01:46<br \/>\npregnancies and their outcomes<br \/>\n01:47<br \/>\ngynecologic issues genetic screening<br \/>\n01:50<br \/>\nissues and social history smoking during<br \/>\n01:53<br \/>\npregnancy has well-known risks including<br \/>\n01:55<br \/>\nmiscarriage placental abruption fetal<br \/>\n01:57<br \/>\ngrowth restriction preterm delivery<br \/>\n01:59<br \/>\nbirth defects and sudden infant death<br \/>\n02:01<br \/>\nsyndrome alcohol is a known teratogen<br \/>\n02:04<br \/>\nalcohol consumption during pregnancy is<br \/>\n02:06<br \/>\na leading preventable cause of mental<br \/>\n02:08<br \/>\nretardation developmental delay and<br \/>\n02:10<br \/>\nbirth defects in the fetus other<br \/>\n02:12<br \/>\nimportant issues<br \/>\n02:13<br \/>\ndiscuss our drugs environmental and<br \/>\n02:15<br \/>\nhealth hazards domestic violence which<br \/>\n02:17<br \/>\noccurs with high prevalence during<br \/>\n02:18<br \/>\npregnancy and seatbelt use one of the<br \/>\n02:21<br \/>\nmost important aspects of the first<br \/>\n02:23<br \/>\nprenatal visit is establishment of the<br \/>\n02:25<br \/>\nestimated date of delivery remember that<br \/>\n02:27<br \/>\nwe use gestational age that starts on<br \/>\n02:29<br \/>\nthe first day of her last menstrual<br \/>\n02:30<br \/>\nperiod the estimated date of delivery or<br \/>\n02:32<br \/>\nEDD is calculated as 40 weeks past the<br \/>\n02:35<br \/>\nLMP if she has regular 28-day cycles<br \/>\n02:38<br \/>\nvaginal ultrasound can be used to<br \/>\n02:40<br \/>\ndetermine the EDD if the patient cycles<br \/>\n02:43<br \/>\nare irregular or to confirm the EDD if<br \/>\n02:45<br \/>\nthe patient cycles are regular since<br \/>\n02:48<br \/>\nnewly is a normal low-risk pregnancy she<br \/>\n02:50<br \/>\nwill be seen at four week intervals<br \/>\n02:52<br \/>\nuntil 28 weeks than every two weeks<br \/>\n02:54<br \/>\nuntil 36 weeks than every week until<br \/>\n02:56<br \/>\ndelivery during each of these visits she<br \/>\n02:59<br \/>\nwill have a weight blood pressure and<br \/>\n03:01<br \/>\nfetal assessment for diabetes screening<br \/>\n03:05<br \/>\nthere will be a one-hour glucose<br \/>\n03:06<br \/>\ntolerance test between 24 and 28 weeks<br \/>\n03:09<br \/>\nto screen for gestational diabetes for<br \/>\n03:11<br \/>\nobese women the diabetes screening<br \/>\n03:13<br \/>\nshould occur at the initial prenatal<br \/>\n03:15<br \/>\nvisit how do we monitor the fetus during<br \/>\n03:17<br \/>\nnewly&#8217;s pregnancy fetal heart rate can<br \/>\n03:20<br \/>\nbe verified with a Doppler device<br \/>\n03:22<br \/>\nstarting in about 12 weeks chromosomal<br \/>\n03:25<br \/>\nscreening provides the probability of<br \/>\n03:26<br \/>\nchromosomal abnormalities the first<br \/>\n03:29<br \/>\ntrimester screen provides the<br \/>\n03:30<br \/>\nprobability of trisomy 21 and tries to<br \/>\n03:33<br \/>\nbe 18 it is performed between 10 and 13<br \/>\n03:35<br \/>\nweeks it is an ultrasound assessment of<br \/>\n03:37<br \/>\nthe nuchal translucency and a maternal<br \/>\n03:40<br \/>\nserum test of PAP a and free beta HCG<br \/>\n03:43<br \/>\nalternatively maternal serum screening<br \/>\n03:46<br \/>\nalso provides probabilities of<br \/>\n03:47<br \/>\nchromosomal abnormalities<br \/>\n03:49<br \/>\nthis is performed between 15 and 20<br \/>\n03:50<br \/>\nweeks the triple test consists of<br \/>\n03:53<br \/>\nalpha-fetoprotein s3l HCG and the quad<br \/>\n03:56<br \/>\ntest consists of alpha-fetoprotein stl<br \/>\n03:59<br \/>\nHCG and inhibin the fetal survey<br \/>\n04:02<br \/>\nultrasound is performed between<br \/>\n04:03<br \/>\napproximately 18 to 20 weeks if we are<br \/>\n04:06<br \/>\nespecially concerned about the fetus for<br \/>\n04:08<br \/>\nconditions such as maternal diabetes<br \/>\n04:09<br \/>\nhypertension or fetal growth restriction<br \/>\n04:12<br \/>\nthen we will monitor the fetus more<br \/>\n04:14<br \/>\nclosely with non-stress test the<br \/>\n04:17<br \/>\nnon-stress test measures fetal heart<br \/>\n04:18<br \/>\nrate patterns and accelerations by an<br \/>\n04:20<br \/>\nexternal transducer for at least 20<br \/>\n04:22<br \/>\nminutes it is considered reactive if<br \/>\n04:24<br \/>\nthere are at least two accelerations<br \/>\n04:26<br \/>\nover the twin<br \/>\n04:26<br \/>\nminute period maternal kick counts are<br \/>\n04:29<br \/>\naway for newly to reassure herself of<br \/>\n04:31<br \/>\nfetal well-being starting at around<br \/>\n04:33<br \/>\nthirty two weeks if she is concerned<br \/>\n04:35<br \/>\nabout decreased fetal movement then she<br \/>\n04:37<br \/>\nshould lay on her side and she should<br \/>\n04:38<br \/>\nfeel five movements in one hour or ten<br \/>\n04:40<br \/>\nmovements in two hours let&#8217;s now move to<br \/>\n04:43<br \/>\nfetal growth the most commonly used<br \/>\n04:45<br \/>\nassessment of growth is fundal height<br \/>\n04:47<br \/>\nmeasurement this measures the distance<br \/>\n04:49<br \/>\nfrom the pubic symphysis to the top of<br \/>\n04:51<br \/>\nthe fundus the fundal height measurement<br \/>\n04:52<br \/>\nis approximately the number of weeks<br \/>\n04:54<br \/>\ngestation amniotic fluid volume is<br \/>\n04:57<br \/>\nassessed with an amniotic fluid index<br \/>\n04:59<br \/>\nthis is a four quadrant assessment of<br \/>\n05:01<br \/>\namniotic fluid pockets decreased<br \/>\n05:03<br \/>\namniotic fluid is secondary to the fetus<br \/>\n05:05<br \/>\nshunting blood away from the kidneys to<br \/>\n05:07<br \/>\nthe brain which leads to decreased urine<br \/>\n05:09<br \/>\noutput let&#8217;s now talk about fetal lung<br \/>\n05:12<br \/>\nmaturity the respiratory system is the<br \/>\n05:15<br \/>\nlast fetal system to mature functionally<br \/>\n05:17<br \/>\nand if newly has to be delivered preterm<br \/>\n05:18<br \/>\nthen it can be sometimes helpful to<br \/>\n05:21<br \/>\nassess fetal lung maturity this is done<br \/>\n05:23<br \/>\nby sampling her amniotic fluid through<br \/>\n05:25<br \/>\nan amniocentesis procedure and checking<br \/>\n05:27<br \/>\nfor markers of lung maturity what our<br \/>\n05:30<br \/>\nnew Lee&#8217;s unique nutritional needs<br \/>\n05:32<br \/>\nduring pregnancy for folic acid she<br \/>\n05:35<br \/>\nshould take at least 0.4 milligrams of<br \/>\n05:37<br \/>\nfolic acid daily starting around the<br \/>\n05:39<br \/>\ntime of conception and this<br \/>\n05:40<br \/>\nsignificantly reduces the risk of neural<br \/>\n05:42<br \/>\ntube defects if she&#8217;s had a pregnancy<br \/>\n05:44<br \/>\naffected by a neural tube defect and she<br \/>\n05:46<br \/>\nshould take four grams of folic acid<br \/>\n05:48<br \/>\ndaily excessive weight gain during<br \/>\n05:50<br \/>\npregnancy leads to an increased risk of<br \/>\n05:52<br \/>\npregnancy complications such as fetal<br \/>\n05:54<br \/>\nmacrosomia it significantly also<br \/>\n05:56<br \/>\nincreases the risk of postpartum obesity<br \/>\n05:58<br \/>\nweight gain recommendations are based on<br \/>\n06:01<br \/>\npre pregnancy BMI for a pre pregnancy<br \/>\n06:04<br \/>\nBMI less than 19 point eight the weight<br \/>\n06:06<br \/>\ngain recommendation is 28 to 40 pounds<br \/>\n06:08<br \/>\nfor nineteen point eight to twenty six<br \/>\n06:10<br \/>\nrecommended is 25 to 35 pounds for 26 to<br \/>\n06:14<br \/>\n29 it is 15 to 25 pounds and if the pre<br \/>\n06:17<br \/>\npregnancy BMI is greater than 29 pounds<br \/>\n06:19<br \/>\nthe recommended weight gain is 11 to 20<br \/>\n06:21<br \/>\npounds alternatively inadequate weight<br \/>\n06:24<br \/>\ngain in pregnancy is associated with<br \/>\n06:26<br \/>\npreterm delivery intrauterine growth<br \/>\n06:28<br \/>\nrestriction and low birth weight<br \/>\n06:30<br \/>\nthere are also foods with specific risks<br \/>\n06:33<br \/>\nduring pregnancy unpasteurized milk and<br \/>\n06:35<br \/>\ndairy products and cold lunch meats<br \/>\n06:37<br \/>\ncould potentially carry listeriosis<br \/>\n06:38<br \/>\nwhich causes an increased risk of<br \/>\n06:40<br \/>\nand fetal demise fish is a great source<br \/>\n06:43<br \/>\nof omega-3 oils however large fish such<br \/>\n06:45<br \/>\nas tuna shark and king mackerel have a<br \/>\n06:48<br \/>\nhigher mercury content because they eat<br \/>\n06:50<br \/>\nthe smaller fish and should be avoided<br \/>\n06:52<br \/>\nduring pregnancy herbal remedies are not<br \/>\n06:55<br \/>\nregulated and therefore pregnant women<br \/>\n06:56<br \/>\nshould be counseled to consider avoiding<br \/>\n06:58<br \/>\nthem<br \/>\n06:58<br \/>\nmoving on to frequently asked questions<br \/>\n07:01<br \/>\ncan newly exercised during pregnancy yes<br \/>\n07:04<br \/>\nshe should avoid exercises that carry<br \/>\n07:06<br \/>\nrisks of falling or abdominal trauma and<br \/>\n07:08<br \/>\nshe probably shouldn&#8217;t start any new<br \/>\n07:10<br \/>\nstrenuous exercises during pregnancy<br \/>\n07:12<br \/>\nthat she did not partake in pre<br \/>\n07:14<br \/>\npregnancy can newly have sex yes unless<br \/>\n07:18<br \/>\nshe is conditions such as placenta<br \/>\n07:19<br \/>\nprevia or premature rupture of membranes<br \/>\n07:21<br \/>\nshe and her partner will likely need to<br \/>\n07:23<br \/>\nwork together to find positions that are<br \/>\n07:25<br \/>\nmore comfortable during pregnancy can<br \/>\n07:27<br \/>\nnewly travel yes most airlines allow<br \/>\n07:30<br \/>\ntravel up to 36 weeks have her avoid<br \/>\n07:33<br \/>\nlong periods of prolonged sitting and<br \/>\n07:34<br \/>\nhave her walk every one to two hours to<br \/>\n07:36<br \/>\npromote circulation remind newly of the<br \/>\n07:39<br \/>\nimportance of seat belts worn low on her<br \/>\n07:41<br \/>\nhip bones should newly expose yourself<br \/>\n07:43<br \/>\nto teratogen during pregnancy no there<br \/>\n07:46<br \/>\nare very few medications that are proven<br \/>\n07:48<br \/>\nhuman traditions common ones to avoid<br \/>\n07:50<br \/>\nour East inhibitors coumadin and<br \/>\n07:52<br \/>\nisotretinoin for ionizing radiation it<br \/>\n07:55<br \/>\nis recommended to limit exposure the<br \/>\n07:57<br \/>\nfetus to less than five rads a CT scan<br \/>\n08:00<br \/>\nof the abdomen and pelvis has<br \/>\n08:01<br \/>\napproximately 3.5 rads a CT scan of the<br \/>\n08:04<br \/>\nhead is approximately less than 1 rad an<br \/>\n08:06<br \/>\nabdominal x-ray is 100 to 200 milli rads<br \/>\n08:09<br \/>\nand a chest x-ray is 0.02 to 0.075 it<br \/>\n08:14<br \/>\nduring newly&#8217;s journey 3 antepartum care<br \/>\n08:16<br \/>\nwe have discussed pregnancy specific<br \/>\n08:18<br \/>\nneeds and considerations and ways of<br \/>\n08:20<br \/>\nassessing fetal well-being and address<br \/>\n08:22<br \/>\nfrequently asked questions<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 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