Bag of water at term between 800 to 1200 cc of fluid

1. From last time Bag of water at term between 800 to 1200 cc of fluid Amnion = inner layer secretes fluid Chorion = outer layer Functions ofamniotic fluid: cushions fetus from injury Separates fetus from membranes Allows freedom of movement; thus allows musculosketetal develop. Maintains constant fetal body temperature Provides oral fluids - acts as excretion collection system Remember the first 12 weeks of PG are critical – Organogenisis - Many women don”t even kn ow they are pregnant EDUCATION IS VITAL

2. Placenta functions as Organ of excretion; Respiration; Elimination Digestion Endocrine Does act as barrier to large molecules & blood cells Organ shared by mom & baby From last time:

3. When talking about teratogens - Cannot forget about medications – Prescribed & over the counter Rational use of any medication requires a risk vs. benefit assessment. The FDA has established 5 categories to indicate the potential of a systemically absorbed drug for causing birth defects. The key differentiation among the categories rests upon the degree (reliability ) of documentation & the risk: benefit Risk. Pregnancy Category X is particularly notable in that if any data exist that may implicate a drug as a teratogen; therefore these drugs are contraindicated in PG Class A: adequate studies have not demonstrated a risk to fetus in first trimester Cass B: animal studies have not demonstrated a risk to fetus BUT are no adequate studies in PG humans Class C: animal studies have shown an adverse effect on fetus, But no adequate studies in PG humans Class D: is evidence of human fetal risk, BUT potential benefits form the use of the drug in PG women maybe acceptable despite the risks Class X: risk outweighs benefit REGARDLESS OF PRESUMED SAFETY, NO DRUGS SHOULD BE ADMINISTERED DURING PG UNLESS IT CLEARLY IS NEEDED & POTENTIAL BENEFITS OUTWEIGH POTENTIAL RISKS

7. When add to other criteria; perfect score for biophysical = 12

9. Does amniotic Fluid give us EDD? Why & when Do you preform Amniocentesis?

11. Fetal assessment

24. Cholsma

26. PUPPP’s - Pruritic Uriticarial Papules and Plaques of Pregnancy unkown cause, occurs 3rd trimester, intense itching, initially 1-2mm papules on abdomen, coalesce into larger plaques, spreads to breasts, back and extremities, Treated with topical steroids, antihistamines

27. See next slide

31. Also increase stress in PG may have something to do with increase glucocorticosteriods to decrease immune system so don’t attack fetus Decrease in IGG Increase in WBC

38. Vaginal exam

41. Diagonal conjugate = measurement with finger between sacral Promontory & lower border of symphasis pubis Obstetrical conjugate or TRUE conjugate = cannot be measured Directly. Is shortest diameter (anterposterior) between sacral Promontory & symphasis pubis

43. Father’s RH factor given delivery Days after implantation le 7 days da

44. What are possible Complaints, why & What can we suggest?

45. Pelvic exercises

47. More reasons for Some common problems thrombophelbitis

48. What does the woman experience ? What can we teach ?

49. Checking for clonus

50. Checking for Deep tendon reflex