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