1 / 88

Pregnancy History and Exam

Pregnancy History and Exam. Adapted from Mosby’s Guide to Physical Examination, 6 th Ed. History. Since pregnancy is a “normal” occurrence, the usual format of the clinical history should be modified Not your typical “8 parameters”. Should Include:. Current Pregnancy (PG) Past Pregnancies

kaden-ballard
Download Presentation

Pregnancy History and Exam

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pregnancy History and Exam Adapted from Mosby’s Guide to Physical Examination, 6th Ed.

  2. History • Since pregnancy is a “normal” occurrence, the usual format of the clinical history should be modified • Not your typical “8 parameters”

  3. Should Include: • Current Pregnancy (PG) • Past Pregnancies • Medical Hx • Contraceptive Hx • Family Hx • Psychological Hx • Plans for Childbirth • Risk Factors

  4. “Chief Complaint” • Patient’s age • Marital status • Gravidity and parity • Last menstrual period (LMP) • Previous usual menstrual period (PUMP) • Expected date of delivery (EDD) • Occupation • Father of the baby and his occupation

  5. “Present Problem” • Description of current PG • Previous medical/health care • Attention should be given to specific problems • Nausea • Vomiting • Fatigue • Edema

  6. Obstetric History • Information on each previous pregnancy • Date of delivery • Length of PG • Weight and sex of infant • Length of labor

  7. Obstetric History (cont’d) • Type of delivery • Spontaneous vaginal • Induced vaginal • Cesarean • Spontaneous or elective abortion • Complications • Pregnancy • Labor • Postpartum • or with the Infant

  8. Medical History • Typical medical history with the addition of risk factors for • AIDS • Hepatitis • Tuberculosis • Exposure to environmental and occupational hazards

  9. Medical History NOTE: • A mother who herself had intrauterine growth restriction (IUGR) carries this risk factor for her children.

  10. Family History In addition to the usual family Hx… • Genetic conditions • Twins • Congenital anomolies

  11. Personal & Social History • Additional information includes • Feelings towards the PG • Whether the PG was planned • Preference for sex of child • Social supports available • Experiences with mothering • History of abuse in relationships

  12. Review of Systems Effects of PG are seen in all systems. • Special attention is given to: • Reproductive system • Cardiovascular system

  13. Review of Systems (cont’d) • Endocrine system • Diabetes • Urinary tract • Infection • Kidney function • Respiratory function • May be compromised… • later PG • tocolytic therapy for preterm labor

  14. Risk Assessment Identify from the Hx and physical exam those conditions that threaten the well-being of the mother and/or fetus. • Diabetes • Pre-term labor • Preeclampsia • Eclampsia • Pregnancy-induced hypertension (PIH)

  15. Weight Gain

  16. Weight Gain • Progressive weight gain is expected during pregnancy, but the amount varies among women.

  17. Weight Gain • The growing fetus accounts for only 5-10 lbs of the total weight gained • The remainder results from an increase in maternal tissues • Placenta • Amniotic fluid • Uterus • Blood and fluid volume • Breasts • Fat reserves See Figure 5.6

  18. Weight Gain • Weight gain should follow a curve through the trimesters of pregnancy • Slow during the first trimester • Rapid during the second • Less rapid during the third

  19. Weight Gain • Maternal tissue growth accounts for most of the weight gain in the 1st and 2nd trimesters • Fetal growth accounts for weight gained in the 3rd trimester

  20. Weight Gain • Weight gain in PG should be calculated from the woman’s prepregnancy weight and BMI See Fig 5-23

  21. Expected Weight GainIdeal Prepregnancy BMI (19.8-26.0)

  22. Always consider… • Woman’s dietary habits • Source of calories • Health status

  23. Please Note • Inadequate weight gain • <20 lbs • often seen in adolescents • May be associated with low-birth-weight infants and other perinatal complications

  24. Nutritional Considerations • Prepregnancy • Folate: neural tube defects • During pregnancy • Protein • Calories • Iron • Folate • Calcium

  25. Nutritional Considerations • Lactation • Calories • Protein • Calcium • Vitamins A and C • Pica

  26. Skin, Hair, and Nails

  27. Overview • Striae gravidarum • Telangiectasias • Hemangiomas • Cutaneous tags • Increased pigmentation • Linea nigra • Chloasma

  28. Striae Gravidarum • “Stretch marks” • May appear over the abdomen, thighs, and breasts • 2nd trimester

  29. Telangiectasias • “Vascular Spiders” • May be found on the face, neck, chest, and arms • Appear during the 2nd-5th month • Usually resolve after delivery

  30. Hemangiomas • Those present before pregnancy may increase in size, or new ones may develop

  31. Cutaneous tags • “Molluscum Fibrosum Gravidarum” • Pedunculated or sessile • Result from epithelial hyperplasia • Most often found on the neck and upper chest

  32. Increased Pigmentation • Common; found to some extent in all pregnant women • Areolae and nipples • Vulvar and perianal regions • Axillae • Linea alba

  33. Linea Nigra • Pigmentation of the linea alba • Extends from the symphysis pubis to the top of the fundus in the midline.

  34. Moles & Freckles • Preexisting pigmented moles (nevi) and freckles may darken • Nevi may increase in size • New nevi may form

  35. Chloasma • “Mask of Pregnancy” • 70% of pregnant women • Hyperpigmentation • forehead, cheeks, bridge of nose, and chin • Blotchy, usually symmetric pattern

  36. “Mask of Pregnancy” • Begins after 16 weeks of gestation • May darken with sun exposure • May be permanent; usually fades after delivery

  37. Other Common Changes Skin, Hair, and Nails

  38. Palmar Erythema • Common finding in pregnancy • Usually disappears after delivery • Cause unknown • Diffuse redness covers the entire palmar surface or the thenar and hypothenar eminences

  39. Itching • Abdomen and breasts • Results from stretching • Common; not a concern • Generallized itching • Starts in the 3rd trimester • Initially affecting the palms and soles before spreading • Sign of a more serious condition

  40. Hair Growth • Altered by hormones • Increased shedding of hair 3-4 months after delivery • main continue for 6-24 weeks

  41. Acne Vulgaris • May be aggravated during the 1st trimester • Often improves in the 3rd trimester

  42. Head & Neck

  43. Thyroid • Must ensure production of sufficient thyroid hormones • compensates for increased iodine clearance during pregnancy • Some degree of goiter may develop if iodine deficient

  44. Thyroid • Because of increased vascularity, a thyroid bruit may be heard

  45. Eyes

  46. Corneal Changes • Mild corneal edema and corneal thickening may occur • 3rd trimester • Can result in hypersensitivity and can change the refractory power of the eye

  47. Krukenberg Spindles • Increase in corneal epithelial pigmentation The corneal endothelium (over the iris) contains vertically orientated deposition of pigment

  48. Diabetic Retinopathy • May worsen significantly

  49. Contact Lenses • Tears contain an increased level of lysosome • “greasy” sensation • blurred vision Because of various changes in the eye, new lens prescriptions should not be obtained until several weeks after delivery.

  50. Other Changes in the Eye • Intraocular pressure falls • latter half of the pregnancy • Ptosis may develop • “unknown reasons” • Subconjunctival hemorrhages • occur spontaneously in pregnancy or during labor • resolve spontaneously

More Related