all charts and diagnostics
TRANSCRIPT
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LABORATORY VALUES FOR PREGNANT AND NONPREGNANT WOMEN
VALUES NONPREGNANT PREGNANT
HEMATOLOGIC
COMPLETE BLOOD COUNT (CBC)
Hemoglobin, g/dl 12-16* >11*
Hematocrit, packed cell volume (PCV), 37-47* >33*
Red blood cell (RBC) volume, per ml 1600 1500-1900
Plasma volume, per ml 2400 3700
RBC count, million per mm3 4.2-5.4 5-6.25
White blood cells, total per mm3 5000-10,000 5000-1 5,000
Neutrophils, % 55-70 60-85
Lymphocytes, % 20-40 15-40
Erythrocyte sedimentation rate, mm/hr 20 Elevated in second and third trimesters
Mean corpuscular hemoglobin concentration
(MCHC), g/dl packed RBCs
32-36 No change in hemoglobin concentration
Mean corpuscular hemoglobin (MCH), pg 27-31 No change per pg (less than I ng)
Mean corpuscular volume (MCV),
cubic micrometer
80-95 No change per cubic micrometer
BLOOD COAGULATION
AND
FIBRINOLYTIC ACTIVITY
Factor VII 65-140 Increase in pregnancy, return to normal in
early puerperium
Factor VIII 55-145 Increases during pregnancy and immediatafter birth
Factor IX 60140 See Factor VII
Factor X 45155 See Factor VII
Factor XI 65-135 Decrease in pregnancy
Factor XII 50150 See Factor VII
Prothrombin time (PT), sec 11-12.5 Slight decrease in pregnancy
Partial Thromboplastin time (PTT), sec 6070 Slight decrease in pregnancy and decrease
during second and third stage of labor
(indicates dotting at placental Site)
Bleeding time, min 1-9 (Ivy test) No appreciable" changeCoagulation time, min 6-1 0
(Lee/white test)
No appreciable change
Platelets, per mm3 150,000-400,000 No Significant change until 3-5 days after
birth and then a rapid increase (may
predispose woman to thrombosis) and
gradual return to normal
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Fibrinolytic activity Normal Decreases in pregnancy and then abruptly
returns to normal (protection against
thromboembolism)
Fibrinogen, mg/dl 200400 Increased levels late in pregnancy
MINERAL AND VITAMIN CONCENTRATIONS
Vitamin B12, folic acid, ascorbic acid Normal Moderate decreaseSERUM PROTEINS
Total, g/dl 6.4-8.3 5.5-7.5
Albumin, g/dl 3.5-5 Slight increase
Globulin, total, g/dl 2.3-3.4 3-4
BLOOD GLUCOSE
Fasting, mg/dl 70105 Decreases
2-hr postprandial, mg/dl
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CARDIOVASCULAR CHANGES IN PREGNANCY
Heart rate Increases 10-15 beats/minBlood pressure Remains at pre pregnancy levels in first trimester (systolic)
Slight decrease in second trimester (systolic and diastolic) Returns to pre pregnancy levels in late third trimester (diastolic)
Blood volume Increases by 1500 ml or 40%-50% above pre pregnancy levelRed blood cell mass Increases 17%Hemoglobin DecreasesHematocrit DecreasesWhite blood cell count Increases in second and third trimestersCardiac output Increases 30%-50%
RESPIRATORY CHANGES IN PREGNANCY
Respiratory rate Unchanged or slightly increased
Tidal volume Increased 30%-40%
Vital capacity Unchanged
Inspiratory capacity Increased
Expiratory volume Decreased
Total lung capacity Unchanged to slightly decreased
Oxygen consumption Increased 15%-20%
FREQUENCY OF DERMATOLOGIC DISORDERS OF PREGNANCY
Cholestasis of pregnancy: Common-I.5%-2%
Pruritic urticarial papules and plaques of pregnancy (PUPPP):Common-O.25% to 1%
Pruritic of pregnancy: Uncommon-O.3%
Herpes gestations: Rare-O.002%
Impetigo herpetiformis: Very rare
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KEY POINTS
The biochemical, physiologic, and anatomic adaptations that occur during pregnancy are profound andrevert to the non-pregnant state after birth and lactation.
Maternal adaptations are attributed to the hormones of pregnancy and to mechanical pressures exerted bthe enlarging uterus and other tissues
ELISA testing, with monoclonal antibody technology, is the most popular method of pregnancy testing andthe basis for most over-the-counter home pregnancy tests.
Presumptive, probable, and positive signs of pregnancy aid in the diagnosis of pregnancy; only positive sig(identification of a fetal heartbeat, verification of fetal movements, and visualization of the fetus) can
establish the diagnosis of pregnancy
Adaptations to pregnancy protect the woman's normal physiologic functioning, meet the metabolicdemands pregnancy imposes, and provide for fetal development and growth needs.
Although the pH of the pregnant woman's vaginal secretions is more acidic, she is more vulnerable to somvaginal infections, especially yeast infections.
Increased vascularity and sensitivity of the vagina and other pelvic viscera may lead to a high degree ofsexual interest and arousal.
Some adaptations to pregnancy result in discomforts such as fatigue, urinary frequency, nausea, and breasensitivity.
As pregnancy progresses, balance and coordination are affected by changes in the woman's joints and hercenter of gravity.
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SIGNS OF PREGNANCY
TIME OF
OCCURRENCE
(GESTATIONAL AGE)
PRESUMPTIVE SIGNS
SIGN OTHER POSSIBLE CAUSE
3-4wk Breast changes Premenstrual changes, oral contraceptiv4wk Amenorrhea Stress, vigorous exercise, early menopau
endocrine problems, malnutrition
4-14 wk Nausea, vomiting Gastrointestinal virus, food poisoning
6-12 wk Urinary frequency Infection, pelvic tumors
12wk Fatigue Stress, illness
16-20 wk Quickening Gas, peristalsis
PROBABLE SIGNS
5wk Goodell sign Pelvic congestion
6-8wk Chadwick sign Pelvic congestion
6-12 wk Hegar sign Pelvic congestion4-12 wk Positive result of pregnancy test (serum) Hydatidiform mole, choriocarcinoma
6-12 wk Positive result of pregnancy test (urine) False-positive results may be caused by
pelvic infection, tumors
16wk Braxton Hicks contractions Myomas, other tumors
16-28 wk Ballottement Tumors, cervical polyps
POSITIVE SIGNS
5-6 wk Visualization of fetus by real-time
ultrasound examination
No other causes
6wk Fetal heart tones detected by ultrasound
examination
No other causes
16wk Visualization of fetus by radiographic
study
No other causes
8-17wk Fetal heart tones detected by Doppler
ultrasound stethoscope
No other causes
17-19 wk Fetal heart tones detected by fetal
stethoscope
No other causes
19-22 wk Fetal movements palpated No other causes
Late pregnancy Fetal movements visible No other causes
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MILESTONES IN HUMAN DEVELOPMENT BEFORE BIRTH SINCE LAST MENSTRUAL PERIOD
4 WEEKS 8 WEEKS 12 WEEKSEXTERNAL APPEARANCE
Body flexed, C-shaped; arm and leg buds
present; head at right angles to body
EXTERNAL APPEARANCE
Body fairly well formed; nose flat, eyes
far apart; digits well formed; head
elevating; tail almost disappeared; eyes,ears, nose, and mouth recognizable
EXTERNAL APPEARANCE
Nails appearing; resembles a human; head
erect but disproportionately large; skin pin
delicate
CROWN-TORUMP MEASUREMENT WEIGHT
0.4-0.5cm;0.4 g
CROWN-TORUMP MEASUREMENT
WEIGHT
2.5-3 cm; 2 g
CROWN-TORUMP MEASUREMENT WEIG
6-9 cm; 19 g
GASTROINTESTINAL SYSTEM
Stomach at midline and fusiform;
conspicuous liver; esophagus short; intestine
a short tube
GASTROINTESTINAL SYSTEM
Intestinal villi developing; small intestines
coil within umbilical cord; palatal folds
present; liver very large
GASTROINTESTINAL SYSTEM
Bile secreted; palatal fusion complete;
intestines have withdrawn from cord and
assume characteristic positions
MUSCULOSKELETAL SYSTEM
All somites present
MUSCULOSKELETAL SYSTEM
First indication of ossification--occiput,
mandible, and humerus; fetus capable of
some movement; definitive muscles of
trunk, limbs, and head well represented
MUSCULOSKELETAL SYSTEM
Some bones well outlined, ossification
spreading; upper cervical to lower sacral
arches and bodies ossify; smooth muscle
layers indicated in hollow viscera
CIRCULATORY SYSTEM
Heart develops, double chambers visible,
begins to beat; aortic arch and major veins
completed
CIRCULATORY SYSTEM
Main blood vessels assume final plan;
enucleated red cells predominate in
blood
CIRCULATORY SYSTEM
Blood forming in marrow
RESPIRATORY SYSTEM
Primary lung buds appear
RESPIRATORY SYSTEM
Pleural and pericardial cavities forming;
branching bronchioles; nostrils closed by
epithelial plugs
RESPIRATORY SYSTEM
Lungs acquire definite shape; vocal cords
appear
RENAL SYSTEM
Rudimentary ureteral buds appear
RENAL SYSTEM
Earliest secretory tubules differentiating;
bladder-urethra separates from rectum
RENAL SYSTEM
Kidney able to secrete urine; bladder expa
as a sac
NERVOUS SYSTEMWell-marked midbrain flexure; no hindbrain
or cervical flexures; neural groove closed
NERVOUS SYSTEMCerebral cortex begins to acquire typical
cells; differentiation of cerebral cortex,
meninges, ventricular foramina,
cerebrospinal fluid circulation; spinal
cord extends entire length of spine
NERVOUS SYSTEMBrain structural configuration almost
complete; cord shows cervical and lumbar
enlargements; fourth ventricle foramina ar
developed; sucking present
SENSORY ORGANS
Eye and ear appearing as optic vessel and
otocyst
SENSORY ORGANS
Primordial choroid plexuses develop;
large relative to cortex; development
progressing; eyes converging rapidly;
internal ear developing; eyelids fuse
SENSORY ORGANS
Earliest taste buds indicated; characteristic
organization of eye attained
GENITAL SYSTEM
Genital ridge appears (fifth week)
GENITAL SYSTEM
Testes and ovaries distinguishable;external genitalia sexless but begin to
differentiate
GENITAL SYSTEM
Sex recognizable; internal and external sexorgans specific
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40 cm; 3200+ g
GASTROINTESTINAL SYSTEM
NONE
SIGNIFICANT
GASTROINTESTINAL SYSTEM
NONE
SIGNIFICANT
GASTROINTESTINAL SYSTEM
NONE
SIGNIFICANT
MUSCULO-
SKELETAL SYSTEM
Middle fourth phalanxes ossify; permanent,minimum tone teeth primordia seen; can turn
head to side
MUSCULO-
SKELETAL SYSTEM
NONESIGNIFICANT
MUSCULO-
SKELETAL SYSTEM
36 WeeksDistal femoral ossification centers present;
sustained, definite movements; fair tone; c
turn and elevate head
40 Weeks
Active, sustained movement; good tone; m
lift head
CIRCULATORY SYSTEM
NONE
SIGNIFICANT
CIRCULATORY SYSTEM
NONE
SIGNIFICANT
CIRCULATORY SYSTEM
NONE
SIGNIFICANT
RESPIRATORY SYSTEM
Lecithin forming on alveolar surfaces
RESPIRATORY SYSTEM
LS ratio = 1.2: I
RESPIRATORY SYSTEM
36 Weeks
LS ratio> 2: I40Weeks
Pulmonary branching only two thirds
complete
RENAL SYSTEM
NONE
SIGNIFICANT
RENAL SYSTEM
NONE
SIGNIFICANT
RENAL SYSTEM
36 Weeks
Formation of new nephrons ceases
NERVOUS SYSTEM
Appearance of cerebral fissures, convolutions
rapidly appearing; indefinite sleep-wake
cycle; cryweak or absent; weak suck reflex
NERVOUS SYSTEM
NONE
SIGNIFICANT
NERVOUS SYSTEM
36 Weeks
End of spinal cord at level of third lumbar
vertebra (L3); definite sleep-wake cycle
40 Weeks
Myelination of brain begins; patterned slee
wake cycle with alert periods; cries when
hungry or uncomfortable; strong suck refle
SENSORY ORGANS
Eyelids reopen; retinal layers completed,
light-receptive; pupils capable of reacting to
light
SENSORY ORGANS
Sense of taste present; aware of sounds
outside mother's body
SENSORY ORGANS
NONE
SIGNIFICANT
GENITAL SYSTEM
NONE
SIGNIFICANT
GENITAL SYSTEM
Testes descending to scrotum
GENITAL SYSTEM
40 Weeks
Testes in scrotum; labia majora well
developed
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DAILY FOOD GUIDE FOR PREGNANCYAND LACTATIONFOOD GROUP DAILY AMOUNT OF FOOD
RECOMMENDED FOR WOMEN*
SERVING SIZE
GRAINS 6 ounce-equivalents
At least half of grain servings should be
whole grains. Whole groins are those that
contain the entire grain kernel (bran,germ, endosperm), e.g., whole wheat or
cornmeal, oatmeal, and brown rice.
Refined grains have been milled to remove
the bran and germ, e.g., white flour, white
bread. Degermed cornmeal, white rice,
and corn or flour tortillas.
I ounce-equivalent = I slice bread. I cup read
to-eat cereal, or '12 cup cooked rice or pasta
cooked cereal
VEGETABLES
Vary the vegetables consumed to take advantage of the
different nutrients they offer.
2.5 Cups
Weekly intake should include at least the
following: 3 cups dark green vegetables
(e.g., spinach or greens, broccoli, bok choy,
romaine lettuce); 2 cups orange vegetables
(e.g., carrots; acorn, butternut, or hubbard
squash; sweet potatoes); 3 cups dry beans
or peas (e.g., black, navy, or kidney beans;chickpeas; black-eyed peas; split peas;
lentils; soy beans; tofu); 3 cup starchy
vegetables (corn, green peas, potatoes);
and 6.5 cups of other vegetables (e.g.,
artichokes, asparagus. bean sprouts.
Brussels sprouts green beans, cauliflower,
cucumber, tomatoes, iceberg or head
lettuce, vegetable juice).
I cup = 2 cups raw leafy greens; I cup of othe
vegetables, raw or cooked; or I cup of vegeta
juice
FRUITS 1.5 cups I cup = I cup raw, frozen or canned fruit;
I cup 100% juice; or 'h cup dried fruit
MILK, YOGURT, AND CHEESE (MILK GROUP) 3 cups
For nonpregnant and pregnant; 4 for
lactation
Most milk group choices should be fat-freeor low-fat.
I cup = I cup milk or yogurt; 1.5 ounces natu
cheese; 2 ounces processed cheese (such as
American); 2 cups cottage cheese;
1.5 cups ice cream (choose fat-free or low-famost often)
MEAT, POULTRY, FISH, DRY BEANS, EGGS, AND NUTS
(MEAT AND BEANS GROUPS)
5 ounce-equivalents
Most meat and poultry choices should be
lean or low-fat. Fish, nuts, and seeds
contain healthy oils. so choose these foods
frequently instead of meat or poultry.
I ounce-equivalent = I ounce (30 g) meat,
poultry, or fish; cup cooked dry beans, I eg
tablespoon (15 ml) peanut butter;
ounce nuts or seeds
OILS 6 teaspoons (30 ml)
Choose oils rather than solid fats. Solid fats
are fats that are solid at room
temperature, such as butter, shortening,
stick margarine, and pork, chicken, or beef
fat: Read the label: choose products with
no trans fats. Limit intake of saturated fats,
and choose oils high in monounsaturatedand polyunsaturated
Fats
I teaspoon = I teaspoon liquid oil (olive, cano
sunflower, safflower. peanut, soybean,
cottonseed, etc.) or soft margarine (tub or
squeeze bottle); I tablespoon mayonnaise or
Italian salad dressing; 3/4 tablespoon Thous
Island salad dressing; 8 large olives; 1/6
medium avocado; 1/3 ounce dry roasted
peanuts, mixed nuts, cashews, sunflower se
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POPULAR FOODS OF VARIOUS CULTURAL AND ETHNIC GROUPS AND THEIR PLACE IN MYPYRAMID
CULTURAL OR ETHNIC GROUP OR EATING PATIERN
FOOD GROUPS
CULTURAL AND
ETHNIC GROUPS
GRAINS VEGETABLE FRUIT MILK MEAT AND BEANS
Mexican Tortilla
Taco shell
Posole (corn soup)
Rice Postres
(pastries]"
Other vegetables:
Chayote (Mexican
squash) Jicama (root
vegetable)
Nopales (cactus
leaves) Tomato
Corn
Avocado
Mango
Papaya
Plantano (cooking
banana)
Zapote (sweet,
yellowish fruit)
Queso Blanco (white
Mexican cheese)
Custard (I cup = I cup
milk serving) Leche
(milk)
Chorizo (sausage)*
Chicken, beef, goat, or
pork Beans. Dry, cooked
African-American
soul food (Southern-
style cooking)
Biscuit Cornbread
Grits, rice, macaroni,
or noodles Hominy
Crackers Hush
puppies
Dark green: Collard,
kale, mustard, or
turnip greens Orange:
Sweet potatoes
Other: Okra Snap,
pole, Lima, and butter
beans Turnips
Summer squash
(yellow or zucchini)
Coleslaw
Blackberries Melons
Muscadines
(grapes)Peaches
Buttermilk Pork (cured ham and
uncured cuts), chicken,
beef, fish Peas or beans
(black-eyed, crowder,
purple-hull, or cream)
Vegetarian Whole-grain bread
Cereal, cooked or
ready to-eat Brown
rice Whole-grain pasta
Bagel
All All Milk and cheese
(Iactovegetarians) Soy
milk, calcium-fortified
Soy cheese
Cooked dry beans or pe
Tofu (soybean curd) or
tempeh (fermented soy
Nuts or seeds Peanut
butter Egg
(ovovegetarians)
Italian Bread sticks, breads
Gnocchi (dumplings)
Polenta (corn meal
mush) Risotto (creamy
rice dish) Pastas
Dark green: Spinach
Other: Artichoke
Eggplant Mushrooms
Marinara sauce
Berries
Figs Pomegranate
Cheeses (mozzarella,
parmesan, Romano,
ricotta, etc.) Gelato
(Italian ice cream)
Veal or beef
Fish
Sausage*
Luncheon meats*
Lentils
SquidAlmonds, pistachios
Chinese Rice or millet Rice
vermicelli (thin rice
pasta) Cellophane
noodles (bean thread)
Steamed rolls Rice
congee (soup) Rice
sticks
Other: Pea pods Yard-
long beans Baby corn
Bamboo shoots Straw
mushrooms Eggplant
Bitter melon
Guava Lychee
Persimmon Pummelo
Kumquat Star fruit
Soy milk Pork, fish, chicken Shrim
crab, lobster Tofu or
tempeh
Indian (south Asia) Breads: roti (chapati),
naan, paratha, batura,
puris, dosa, Idli Rice or
rice pilau Pooha,
upma, sabudana
Dark green:
Saag (mixed greens
and
potatoes)
Spinach
Other:Green peppers
Cabbage
Eggplant
Green beans
Methi (fenugreek
leaves)
Cucumbers
Chutney or vegetable
pickles
Mango
Dates
Raisins
Melons
Figs
Fruit juices andnectars
Yogurt Dal (lentils, mung beans
other dried beans)
Beef, chicken (some are
vegetarian)
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Native American Bread
Fry bread
Wild rice or oats
Popcorn
Tortilla
Mush (cooked cereal)
Orange:
Winter squash (hard
outer
shell)
Starchy:
Potato
Corn
Other:Rhubarb
Berries
Cherries
Plums
Apples
Peaches
Wild game (deer, rabbit
elk,
beaver)
Lamb
Salmon and other fish
Clams, mussels
Crab
Duck or quail
Middle Eastern Rice or bulgur
(cracked
wheat)
Couscous
Bread
Pita
Yellow:
Pumpkin or winter
squash
(Butternut)
Other:
Peppers
Tomatoes
Grape leaves
Cucumbers
Fava beans
Eggplant
Apricots
Grapes
Melons
Dried fruits: dates,
raisins,
apricots
Yogurt Lamb, goat, fish
Almonds
Pistachio nuts
Dried beans and peas,
lentils
Egg
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Calculating the Body Mass Index (BMI) Example: Mrs. White is 54 tall and weighs 130 lbs. Todetermine her BMI:
Convert weight into kilograms. (divide weight inpounds by 2.2)
130 / 2.2 = 59 kg
Convert height into centimeters. (multiply heightin inches by 2.5)
5 x 12 = 60 + 4 = 64 inches (foot to inches)
64 inches x 2.5 = 160 cm (inches to cm)
Convert centimeters into meters. (divide result by100)
160 / 100 = 1.6 meters
Square height in meters. 1.6 x 1.6 = 2.56 Divide weight in kilograms by height in meters
squared.59 / 2.56 = 23 BMI
nterpretation of Result:
23 BMI = Normal Weight, thus, Mrs. White enters pregnancy at normal weight.
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LABORATORY TESTS IN PRENATAL PERIOD
LABORATORY TEST PURPOSE
Hemoglobin, hematocrit, WBC, differential Detects anemia; detects infection
Hemoglobin electrophoresis Identifies women with hemoglobinopathies (e.g., sic
cell anemia, thalassemia)
Blood type, Rh, and irregular antibody Identifies those fetuses at risk for developingerythroblastosis
fetalis or hyperbilirubinemia in neonatal period
Rubella titer Determines immunity to rubella
Tuberculin skin testing; chest film after 20 weeks of gestation in
women with reactive tuberculin tests
Screens for exposure to tuberculosis
Urinalysis, including microscopic examination of urinary
sediment; pH, specific gravity, color, glucose, albumin, protein,
RBCs, WBCs, casts, acetone; hCG
Identifies women with unsuspected diabetes mellitu
renal
disease, hypertensive disease of pregnancy; infectio
occult
hematuria
Urine culture Identifies women with Asymptomatic bacteriuria
Renal function tests: BUN, creatinine, electrolytes, creatinine
clearance, total protein excretion
Evaluates level of possible renal compromise in wom
with a
history of diabetes, hypertension, or renal disease
Pap test Screens for cervical intraepithelial neoplasia. herpes
simplex type 2,and HPV
Vaginal or rectal smear for Neisseria gonorrhea, Chlamydia, HPV,
GBS
Screens high risk population for asymptomatic
infection; GBS
done at 35-37 weeks
RPR,VDRL, or FTA-ABS Identifies women with untreated syphilis
HIV* antibody, hepatitis B surface antigen, toxoplasmosis Screens for specific infections
l-hr glucose tolerance Screens for gestational diabetes; done at initial visit
women
with risk factors; done at 24-28 weeks for all pregna
women
3-hr glucose tolerance Screens for diabetes In women with elevated glucos
level after 1-hr test; must have two elevated reading
for diagnosis
Cardiac evaluation: ECG, chest x-ray film, and echocardiogram Evaluates cardiac function in women with a history o
hypertension or cardiac disease
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Nageles
Rule
Nageles rule is used to determine the EDD on the basis of the first day of the last menstrual period or LMP
calculate the date of birth in this rule, subtract 3 months from the first day of LMP then add 7 days and
change the year. For example the last menstrual period (LMP) began July 30, 2010. To determine the EDD
follow the following steps:
Subtract 3 months (June 30, May 30, April 30) = April 30, 2010 Add 7 days then change the year = April 30 + 7 (April has 30 days only, thus, adding 7 days would make
the EDD May 7) = May 7 (change the year) = May 7, 2011
Modified
McDonalds
Rule
Measuring the fundic height in McDonalds rule
McDonalds Rule or method is used to determine the age of gestation by measuring from the fundus
(obtaining the fundal height) to the symphysis pubis. The distance in centimeters will determine the age of
gestation from 16-38 weeks. (From Benson and Pernolls handbook ofobstetrics and gynecology)
Johnsons
Rule
Johnsons rule is used to estimate the weight of the fetus in grams. To determine this, a standard formula is
used.
Formula: fundic height in cmn x k
k is constant, it is always 155
n is 12 if the fetus is engaged. It is 11 if the fetus is not yet engaged.
Example:
A fundic height of 28 cm, and the fetus is not engaged.
28 cm11 x 155 = 17 x 155 = 2635 grams
Bartholome
ws Rule of
fourths
This method estimates the age of gestation relative to the height of the fundus of the uterus above the
symphysis pubis.
By 3rd
lunar month (12 weeks), the fundus is slightly palpated above the above the symphysis pubis.
By the 5th lunar month (20 weeks), the fundus is palpable at the level of the umbilicus.
On the 9th
lunar month, the fundus is at the level of the xiphoid process.
image from womenshealthapta.org
Haase rule The length of the fetus in centimeters, divided by 5, is the duration ofpregnancy in months, the age of thefetus
http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/estimates-in-pregnancy/http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/estimates-in-pregnancy/http://www.medilexicon.com/medicaldictionary.php?t=79171http://www.medilexicon.com/medicaldictionary.php?t=79171http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/estimates-in-pregnancy/ -
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INVASIVENESS TEST COMMENTS TIME
NON-INVASIVE
Fetal Cells in
Maternal Blood
(FCMB)
Based on enrichment of fetal cells which circulate in maternal blood.
Since fetal cells hold all the genetic information of the developing
fetus they can be used to perform prenatal diagnosis.
First
Trimest
NON-INVASIVECell-free Fetal DNA
in Maternal Blood
Based on DNA of fetal origin circulating in the maternal blood. Testingcan potentially identify
fetalaneuploidy(available in the United States, beginning 2011) and
genderof a fetus as early as six weeks into a pregnancy. Fetal DNA
ranges from about 2-10% of the total DNA in maternal blood.
First
Trimest
NON-INVASIVE
Preimplantation
Genetic
Diagnosis(PGD)
Duringin vitro fertilization(IVF) procedures, it is possible to sample
cells fromhuman embryosprior the implantation.[6]PGD is in itself
non-invasive, but IVF usually involves invasive procedures such
astransvaginal oocyte retrieval
Prior T
Implant
on
NON-INVASIVEExternal
ExaminationExamination of the woman'suterusfrom outside the body.
First O
Secon
Trimest
NON-INVASIVEUltrasound
Detection
Commonly dating scans (sometimes known as booking scans) from 7
weeks to confirm pregnancy dates and look fortwins. The
specializednuchal scanat 1113 weeks may be used to identify
higher risks of Downs syndrome. Latermorphology scans from 18
weeks may check for any abnormal development.
First O
Secon
Trimest
NON-INVASIVE Fetal Heartbeat Listening to the fetal heartbeat (seestethoscope)
First O
Secon
Trimest
NON-INVASIVE Non-Stress TestUse ofcardiotocographyduring the third trimester to monitor fetal
wellbeing
Third
Trimest
LESS INVASIVE
Transcervical
Retrieval Of
Trophoblast Cells
Cervical mucus aspiration,cervical swabbing,andcervicalorintrauterine lavagecan be used to retrieve trophoblast
cells for diagnostic purposes, includingprenatal genetic analysis.
Success rates for retrieving fetal trophoblast cells vary from 40% to
90%.[7]
It can be used forfetal sex determinationand
identifyaneuploidies.Antibody markershave proven useful to select
trophoblast cells for genetic analysis and to demonstrate that the
abundance of recoverable trophoblast cells diminishes in abnormal
gestations, such as inectopic pregnancyoran embryonic gestation.
First
Trimest
LESS INVASIVEMaternal Serum
Screening
Including -hCG,PAPP-A,alpha fetoprotein, intact or beta hCG,
inhibin-A.
See separate sectionbelow
First O
Secon
Trimest
MORE INVASIVEChorionic Villus
Sampling
Involves getting a sample of thechorionic villusand testing it. This
can be done earlier than amniocentesis, but may have a higher risk of
miscarriage, estimated at 1%.
After
10 Wee
MORE INVASIVE Amniocentesis
This can be done once enoughamniotic fluidhas developed to
sample. Cells from the fetus will be floating in this fluid, and can be
separated and tested. Miscarriage risk of amniocentesis is commonly
quoted as 0.06% (1:1600). Byamniocentesisis also possible tocry
After
15 Wee
http://en.wikipedia.org/wiki/Aneuploidyhttp://en.wikipedia.org/wiki/Aneuploidyhttp://en.wikipedia.org/wiki/Aneuploidyhttp://en.wikipedia.org/wiki/Baby_Gender_Mentorhttp://en.wikipedia.org/wiki/Baby_Gender_Mentorhttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/In_vitro_fertilizationhttp://en.wikipedia.org/wiki/In_vitro_fertilizationhttp://en.wikipedia.org/wiki/In_vitro_fertilizationhttp://en.wikipedia.org/wiki/Human_embryohttp://en.wikipedia.org/wiki/Human_embryohttp://en.wikipedia.org/wiki/Human_embryohttp://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-5http://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-5http://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-5http://en.wikipedia.org/wiki/Transvaginal_oocyte_retrievalhttp://en.wikipedia.org/wiki/Transvaginal_oocyte_retrievalhttp://en.wikipedia.org/wiki/Transvaginal_oocyte_retrievalhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Obstetric_ultrasonographyhttp://en.wikipedia.org/wiki/Obstetric_ultrasonographyhttp://en.wikipedia.org/wiki/Obstetric_ultrasonographyhttp://en.wikipedia.org/wiki/Twinhttp://en.wikipedia.org/wiki/Twinhttp://en.wikipedia.org/wiki/Twinhttp://en.wikipedia.org/wiki/Nuchal_scanhttp://en.wikipedia.org/wiki/Nuchal_scanhttp://en.wikipedia.org/wiki/Nuchal_scanhttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Non-stress_testhttp://en.wikipedia.org/wiki/Non-stress_testhttp://en.wikipedia.org/wiki/Cardiotocographyhttp://en.wikipedia.org/wiki/Cardiotocographyhttp://en.wikipedia.org/wiki/Cardiotocographyhttp://en.wikipedia.org/wiki/Transcervicalhttp://en.wikipedia.org/wiki/Transcervicalhttp://en.wikipedia.org/wiki/Trophoblast_cellhttp://en.wikipedia.org/wiki/Trophoblast_cellhttp://en.wikipedia.org/w/index.php?title=Cervical_mucus_aspiration&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_mucus_aspiration&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_swabbing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_swabbing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_swabbing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Intrauterine_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Intrauterine_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Intrauterine_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Prenatal_genetic_analysis&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Prenatal_genetic_analysis&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Prenatal_genetic_analysis&action=edit&redlink=1http://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-imudia-6http://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-imudia-6http://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-imudia-6http://en.wikipedia.org/wiki/Fetal_sex_determinationhttp://en.wikipedia.org/wiki/Fetal_sex_determinationhttp://en.wikipedia.org/wiki/Fetal_sex_determinationhttp://en.wikipedia.org/wiki/Aneuploidieshttp://en.wikipedia.org/wiki/Aneuploidieshttp://en.wikipedia.org/wiki/Aneuploidieshttp://en.wikipedia.org/w/index.php?title=Antibody_marker&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Antibody_marker&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Antibody_marker&action=edit&redlink=1http://en.wikipedia.org/wiki/Ectopic_pregnancyhttp://en.wikipedia.org/wiki/Ectopic_pregnancyhttp://en.wikipedia.org/wiki/Ectopic_pregnancyhttp://en.wikipedia.org/wiki/Anembryonic_gestationhttp://en.wikipedia.org/wiki/Anembryonic_gestationhttp://en.wikipedia.org/wiki/Anembryonic_gestationhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Pregnancy-associated_plasma_protein_Ahttp://en.wikipedia.org/wiki/Pregnancy-associated_plasma_protein_Ahttp://en.wikipedia.org/wiki/Pregnancy-associated_plasma_protein_Ahttp://en.wikipedia.org/wiki/Alpha_fetoproteinhttp://en.wikipedia.org/wiki/Alpha_fetoproteinhttp://en.wikipedia.org/wiki/Alpha_fetoproteinhttp://en.wikipedia.org/wiki/Prenatal_diagnosis#Maternal_serum_screeninghttp://en.wikipedia.org/wiki/Prenatal_diagnosis#Maternal_serum_screeninghttp://en.wikipedia.org/wiki/Prenatal_diagnosis#Maternal_serum_screeninghttp://en.wikipedia.org/wiki/Chorionic_villus_samplinghttp://en.wikipedia.org/wiki/Chorionic_villus_samplinghttp://en.wikipedia.org/wiki/Chorionic_villus_samplinghttp://en.wikipedia.org/wiki/Chorionic_villushttp://en.wikipedia.org/wiki/Chorionic_villushttp://en.wikipedia.org/wiki/Chorionic_villushttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Cryopreservehttp://en.wikipedia.org/wiki/Cryopreservehttp://en.wikipedia.org/wiki/Cryopreservehttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Amniotic_fluidhttp://en.wikipedia.org/wiki/Amniocentesishttp://en.wikipedia.org/wiki/Chorionic_villushttp://en.wikipedia.org/wiki/Chorionic_villus_samplinghttp://en.wikipedia.org/wiki/Chorionic_villus_samplinghttp://en.wikipedia.org/wiki/Prenatal_diagnosis#Maternal_serum_screeninghttp://en.wikipedia.org/wiki/Alpha_fetoproteinhttp://en.wikipedia.org/wiki/Pregnancy-associated_plasma_protein_Ahttp://en.wikipedia.org/wiki/Human_chorionic_gonadotropinhttp://en.wikipedia.org/wiki/Anembryonic_gestationhttp://en.wikipedia.org/wiki/Ectopic_pregnancyhttp://en.wikipedia.org/w/index.php?title=Antibody_marker&action=edit&redlink=1http://en.wikipedia.org/wiki/Aneuploidieshttp://en.wikipedia.org/wiki/Fetal_sex_determinationhttp://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-imudia-6http://en.wikipedia.org/w/index.php?title=Prenatal_genetic_analysis&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Intrauterine_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_lavage&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_swabbing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Cervical_mucus_aspiration&action=edit&redlink=1http://en.wikipedia.org/wiki/Trophoblast_cellhttp://en.wikipedia.org/wiki/Transcervicalhttp://en.wikipedia.org/wiki/Cardiotocographyhttp://en.wikipedia.org/wiki/Non-stress_testhttp://en.wikipedia.org/wiki/Stethoscopehttp://en.wikipedia.org/wiki/Nuchal_scanhttp://en.wikipedia.org/wiki/Twinhttp://en.wikipedia.org/wiki/Obstetric_ultrasonographyhttp://en.wikipedia.org/wiki/Obstetric_ultrasonographyhttp://en.wikipedia.org/wiki/Uterushttp://en.wikipedia.org/wiki/Transvaginal_oocyte_retrievalhttp://en.wikipedia.org/wiki/Prenatal_diagnosis#cite_note-5http://en.wikipedia.org/wiki/Human_embryohttp://en.wikipedia.org/wiki/In_vitro_fertilizationhttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Preimplantation_genetic_diagnosishttp://en.wikipedia.org/wiki/Baby_Gender_Mentorhttp://en.wikipedia.org/wiki/Aneuploidy 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preserveamniotic stem cells.
MORE INVASIVE
Embryoscopy
and
Fetoscopy
Though rarely done, these involve putting a probe into a women's
uterus to observe (with a video camera), or to sample blood or tissue
from the embryo or fetus.
MORE INVASIVE
Percutaneous
Umbilical CordBlood Sampling
http://en.wikipedia.org/wiki/Cryopreservehttp://en.wikipedia.org/wiki/Amniotic_stem_cellshttp://en.wikipedia.org/wiki/Amniotic_stem_cellshttp://en.wikipedia.org/wiki/Amniotic_stem_cellshttp://en.wikipedia.org/w/index.php?title=Embryoscopy&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Embryoscopy&action=edit&redlink=1http://en.wikipedia.org/wiki/Fetoscopyhttp://en.wikipedia.org/wiki/Fetoscopyhttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Percutaneous_umbilical_cord_blood_samplinghttp://en.wikipedia.org/wiki/Fetoscopyhttp://en.wikipedia.org/w/index.php?title=Embryoscopy&action=edit&redlink=1http://en.wikipedia.org/wiki/Amniotic_stem_cellshttp://en.wikipedia.org/wiki/Cryopreserve