Pregnancy

Last updated 05.10.12

   

Definition

-  Fertilisation & development of 1+ embryo

-  Intra-uterine pregnancy = pregnancy within female uterus

-  Livebirth = complete expulsion or extraction from its mother of a product of conception, irrespective of duration of pregnancy, which, after separation, breaths or shows any evidence of life

-  Ectopic pregnancy = pregnancy outside of uterus

 

Features

-  Normal gestation 40 weeks = approximately 9 months

-  Day 0 = first day of LMP

-  Trimesters

-  First trimester = first 3 months (0/40 – 12+6/40)

-  Second trimester = second 3 months (13/40 – 26+6/40) 

-  Third trimester = third 3 months (27/40 – 42/40) until labour

-  Requires early medical R/V to plan model of care & instigate early antenatal investigations

-  Lightening = development of lower uterine segment

-  Decrease in fundal height

-  Improved maternal respiration

-  Engagement of fetal head

-  Perinatal mortality rate (fetal deaths + neonatal deaths per year) 10.2/1,000 births (1%)

-  Fetal death rate (Stillbirth/FDIU): 7.4/1,000 births

-  Neonatal death rate: 2.8/1,000 live births

-   Baby >20/40 or 400g with evidence of life who die within 28 days of birth

-  Maternal mortality: death during pregnancy, labour or peurperium (up to 42 days)

-  Maternal mortality rate 8.4/100,000 (Aus 2008)

-   Indigenous: 21.5/100,000

-   Worldwide: 400/100,000

-   Natural: 1,500/100,000

-  Direct: due to pregnancy

-   Amniotic fluid embolism

-   Hypertensive disease

-   VTE

-   Haemorrhage (APH, PPH)

-  Indirect: underlying condition worsened by pregnancy

-   Cardiac

-   Psychiatirc (incl suicide)

-  Incidental: no definitive link to pregnancy

-  Maternal demographics

-  Average age 29.9 (increasing)

-  16.2% smokers

-  LUSCS rate 31.3%

-  BMI: obesity in pregnancy

 

DDx

-  Other causes of amenorrhoea

-  Ectopic

-  Gestational trophoblastic disease

 

Ix

-  Beta HCG

-  +/- Pelvic US

-  Antenatal Investigations

 

Mx

-  Pre-Pregnancy

- Infectious Serology (as per Antenatal Ix) + CMV serology (best pre-pregnancy)

-  Vaccinate as needed

-  Rubella (MMR): should not get pregnant within 28days of MMR

-  Influenza: can be done at any time prenatally or antenatally

-  Varicella: should not get pregnant within 28days

-  Pertussis (Boostrix): better to be given in third trimester (28-38/40) to conffer some protection to infant

- Infants then require a booster dose at 2yrs 2ld (additional to normal schedule)

-  Pap smear

-  Perform if due

-  Plan/refer if abnormal

-  Note previous interventions as releative to preterm delivery

-  Breast examination

-  Vitals (esp BP)

-  Supplements as appropriate

-  All patients Folic acid +/- iron, iodine & vitamin D

-  Genetic Counselling

-  General Health

-  Nutrition in pregnancy

-  Weight

-  Obesity in pregnancy

-  Weight changes in pregnancy

-  Smoking

-  EtOH

-  Drugs

-  Existing Disease

-  Consider options

-  DM in pregnancy

-  Epilepsy in pregnancy

-  Thyroid disease in pregnancy

-  Venous Thromboembolic Embolism (VTE) in pregnancy

-  HSV in pregnancy

-  Previous Obstetric Hx

-  Fertility

-  ART

-  Antenatal Care

-  Labour

 

 

 

References