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Normal Pregnancy

Normal Pregnancy. CAPT Mike Hughey, MC, USNR. Symptoms of Pregnancy. Nausea (1st TM) Breast and nipple tenderness (1st TM) Marked fatigue (1st & 3rd TM) Urinary frequency (1st & 3rd TM) Patient thinks she’s pregnant. Pregnancy Tests are Very Reliable.

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Normal Pregnancy

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  1. Normal Pregnancy CAPT Mike Hughey, MC, USNR

  2. Symptoms of Pregnancy • Nausea (1st TM) • Breast and nipple tenderness (1st TM) • Marked fatigue (1st & 3rd TM) • Urinary frequency (1st & 3rd TM) • Patient thinks she’s pregnant

  3. Pregnancy Tests are Very Reliable • Turn positive at about the first missed period (4 weeks after the LMP or 14 days after conception. • Detect ~30 units of HCG • Double the sensitivity by doubling the amount of urine.

  4. Serum can be Used • May use serum if urine is unavailable • Tape red-top tube to the wall • After 10 minutes, draw off enough serum to match, drop for drop, the urine required for the test. • Sludging of proteins, albumin can be a problem • Different forms of HCG in urine and serum • Will work well enough for most purposes.

  5. Routine Visits • Q4 weeks until 28 weeks • Q2 weeks, 28-36 weeks • Q week, 36-delivery

  6. Routine Visits • At each visit:

  7. Urine Test for Protein and Glucose • Protein may indicate pre-eclampsia • Glucose may indicate gestational diabetes

  8. Estimating Gestational Age • LMP plus 280 days • Add 7 days, subtract 3 months • MacDonald's Rule (cm = weeks)

  9. Fetal heart beat • You may never hear it with a stethoscope • 16-20 weeks with DeLee Stethoscope • 12-14 weeks with Doppler • 5-6 weeks with ultrasound

  10. Take a Prenatal Vitamin Each Day • Folic Acid 400 mg/day before pregnancy • 600-800 mg/day during pregnancy • Those with a normal balanced diet probably don’t need extra vitamins • No one has a normal balanced diet.

  11. Initial Prenatal Laboratory Tests • Hgb/Hct • WBC • U/A • Blood type & rH • Atypical antibody screen • Rubella titer • RPR or VDRL • Hep B • HIV • GC/Chlamydia • Pap

  12. Subsequent Laboratory Tests • Amniocentesis at 11-17 weeks for women >35 • Serum AFP at 15-18 weeks • Targeted (Level II) ultrasound for women at high risk at 16-20 weeks • Hgb/Hct at 28 weeks • OB Glucose at 28 weeks (1-hour post 50 g oral load) • Rhogam to all rH negative women at 28 weeks

  13. Skin Changes • Chloasma (darkening of face) • Spider telangectasias (red, star-shaped marks) • Stretch marks • Linea nigra • Darkening of nipples

  14. Exercise During Pregnancy • Balance • Joint changes • Heat • Increased cardiac output

  15. Nausea & Vomiting • Common up to 16 weeks • If she can’t keep anything down, or has ketones in urine, give IV fluids • Avoid antiemetics • Benadryl, Scopolomine, Compazine, Phenergan,Reglan have all been used with good results

  16. Heartburn • Reflux esophagitis • Antacids are OK • Suck on them rather than chewing them

  17. Sciatica • 30% of pregnancies • Avoid standing for long periods • Sit with knees slightly higher than the hips

  18. Sciatica • Sleep in semi-fetal position with a pillow between the knees

  19. Carpal Tunnel Syndrome • 30% of pregnancies • Numbness of the distal median nerve due to compression from edema • Worse in the morning • No treatment necessary so long as lesion is sensory only • Rest, wrist splint may be helpful • Injections, surgery almost never necessary

  20. Upper Respiratory Infection • Acetaminaphen - OK • Guaifenisin - OK • Pseudoephedrine - OK in 2nd TM • Triprolidine - OK • Penicillins - OK • Cephalosporins - OK • Erythromycin - OK

  21. Medications During Pregnancy • Antibiotics - some OK, some not • Local anesthetics - OK • Local with epinephrine - not OK • Aspirin - not OK • Immunizations - some are OK, some are not • Antimalarial - some OK, some are not • Narcotics - OK except for addiction issue

  22. Thermal Stress During Pregnancy • Avoid elevation of core temperature • Mess decks • Engine room spaces • Laundry

  23. Acoustic Stress During Pregnancy • Fetus receives about 15 dBA less than the mother. • Avoid exposure in which ear protection is needed. • Brief transit is OK (less than 5 minutes) • If double ear protection required, pregnant woman should avoid the area completely.

  24. Low Frequency Whole Body Vibration • Avoid it if possible

  25. Chemical Exposure During Pregnancy Avoid: • Organic solvents • Fuel oils • Paint thinners • Mercury • Lead • Cadmium

  26. Radiation Exposure During Pregnancy • Avoid radiation exposure • If it's important, then go ahead but shield the abdomen to the extent possible.

  27. Diving During Pregnancy • Don't do it • Pregnant are women predisposed to decompression sickness and embolism. • Fetal circulation bypasses the lungs...any bubble goes directly to the brain or coronary arteries. • Prolonged low hyperbaric pressures may be safe, but fetal effects include narrowing of foramen ovale and ductus arteriosus

  28. Aircrew Status • G forces • Noise • Heat • Balance • Fumes • Rules vary by service, type of aircraft, job, and mission

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