EARLY PREGNANCY DATING: FROM LMP 280 days Naegler’s rule Short cycle vs. long cycle HEGAR’S SIGN - soft uterus CHADWICKS SIGN - blue cervix

Which of the following statements best describes the foramen ovale: a) it shunts blood from right to left b) it connects the pulmonary artery with the aorta c) it shunts deoxygenated blood into the left atrium d) it is an extra cardiac shunt e) it is functional after birth

Other uses BHCG a sub unit similar to TSH LH FSH RIA + 8 days post conception 8 days 8 weeks 16 weeks 5,000 Level 100,000 doubling time 2 days Other uses Zone 2000-6000 Mole Ectopic Ovarian cysts ROLE - stimulate CL progesterone Other placental hormones HPL = placental mass PROLACTIN “growth hormone” PROGESTERONE ESTROGEN

ANTEPARTUM HISTORY ROUTINE TESTS AGE ( > 35 = AMNIOCENTESIS PURITY / GRAVIDITY MEDICAL HISTORY FAMILY HISTORY ROUTINE TESTS HB GROUP, RHESUS SICKLE, THAL, V.D.R.L. RUBELLA/chicken pox HEPATITIS URINE CULTURE 28 WEEK GLUCOSE SCREEN Grp B strep VAG. SWABS HIV ULTRASOUND IPS SPECIAL TESTS CVS AMNIOCENTESIS

a FP SCREEN 16 WKS LEVEL > 2 . 5 MOM 2. . 5 - 2 . 9 > 5 2. . 5 - 2 . 9 > 5 LEVEL < 0 . 5 MOM 20 % RISK 70 % DOWN ‘ S RISK

FIRST TRIMESTER 10 TO 14 WEEKS MSS AT 15 TO 19 WEEKS AFP, ESTRIOL, HCG AGE, WEIGHT RISK CALCULATION WITH ARBITRARY CUT-OFF DETECTS 60-70% OF DOWNS FIRST TRIMESTER 10 TO 14 WEEKS NUCHAL THICKNESS, BHCG, PAPP A INTEGRATED PRENATAL SCREEN MSS PLUS FIRST TRIMESTER DETECTS >90%, FALSE POSITIVE 2%

All of the following hormones are products of placental synthesis or production except: a) human chorionic gonadotropin b) human placental lactogen c) prolactin d) progesterone e) estriol

PLASMA H2O

ANTENATAL CARE F IRST VISIT GENERAL EXAM PAP HISTORY / RISK FACTORS 4 weekly to 28 weeks 2 weekly to 36 weeks 1 weekly to delivery EACH VISIT CHECK: FUNDAL HEIGHT ( CMS ) 12 WKS = SYMPHYSIS 20 WKS = UMBILICUS 36 WKS = XIPHISTERNUM MATERNAL WEIGHT / SYMPTOMS BLOOD PRESSURE URINE PRESENTATION

MATERNAL PHYSIOLOGY RBC PLASMA VOLUME 50 % CARDIAC OUTPUT - highest 1st hour after delivery HEART RATE 20 % STROKE VOLUME Placenta blood flow = 750 ml / min at term Tidal volume Residual volume G F R creatinine cc glycOSURIA “normal proteinura” 0.3 g/l

All of the following factors are associated with an increased risk of perinatal morbidity except: a) low socioeconomic status b) low maternal age c) heavy cigarette smoking d) alcohol abuse e) exercise