5) Hygiene and nutrition in pregnancy. Gestational age and fetal weight estimation formulas.

Question 1

what are main stations in the hygiene pregnancy we touch upon

Answer 1

REST AND SLEEP - strenuous work should be avoided especially the first trimester and the last 4 weeks

HABITS

PHYSICAL ACTIVITY

OCCUPATION

CLOTHING

DEFACATION AND

MICTURINATION

SEXUAL LIFE

DENTAL MOUTH AND CARE

MAMMARY GLANDS

IMMUNISATION DURING PREGNANCY

vaginal discharge - local cleanliness important and if infection immediate local treatmnet

Question 2

WHAT ARE THE CONTRADICTED BAD HABITS IN PREGNANCY ?

Answer 2

not to smoke , drink or take drugs

Question 3

why is alcohol contraindicated in pregnancy ?

Answer 3

alcohol can diffuse through placenta - embryo fetal alcohol syndrome - reduced birth weight , body length , head circumference , development delay , malformation of face , brain and skull

Question 4

why is smoking contraindicated in pregnancy ?

Answer 4

smoking reduces the blood flow to the uterus and placenta -

USUALLY babies born to smokers are always small

other risks from smoking:

PROM

miscarriage

placental abruption

eclampsia/ pre -eclampsia

linked to sudden infant death syndrome and perinatal mortality

Question 5

What are the worrying matters in physical activity of a pregnant women

Answer 5

should be moderate , if its excessive it will be too much stress to your, if you do not exercise than the chance of have thrombus is high

Question 6

how much physical activity is recommenced for a pregnancy women

Answer 6

it is recommended to go walking twice a day

Question 7

occupational wise what are the stuff to avoid

Answer 7

areas with high radiation , chemicals , poisons , same goes for extreme temperatures
especially dangerous is vibration diseases

Question 8

why is vibration really dangerous?

Answer 8

vibration can cause contraction of the uterus - leading to abortion and premature pregnancy

Question 9

what should we take care of in clothing

Answer 9

clothing should no put pressure non the abdomen , neither should women wear tight clothing on their legs - because it can cause varicose veins and swellings

Question 10

why is constipation common in pregnant women ?

Answer 10

hormones such as progesterone that relax the intestinal muscle and the pressure of the expanding uterus on the intestines

Question 11

what is given for constipation

Answer 11

laxatives, fluid fruits and vegetables

Question 12

why is the frequent urination in the beginning of pregnancy ?

Answer 12

in the beginning of pregnancy first trimester -hCG increases the blood flow to the pelvic area , and your kidneys

there is also an increased blood volume

and also pressure on the bladder to the expanding uterus

Question 13

when does urine production peek then drop down and why does it drop down

Answer 13

increased urine production peaks to week 9-16 then settles down , because your kidneys adapt

Question 14

in the third trimester the urine production increases again after going down why is that ?

Answer 14

because the uterus pushes down on the bladder ,and the end of third trimester when the baby’s head moves to the pelvis it presses into the bladder more.

Question 15

why should sex in pregnant women be careful ?

Answer 15

sex increases uterine contractions - due to release of prostaglandins and oxytocin
dangerous for women predisposed for miscarriages or premature delivery

protect the front uterine wall - abdominal wall from pressure during intercourse

Question 16

why is pregnant women predisposed to caries and gingivitis

Answer 16

the hormonal changes increase the blood flow to gum tissue causing the gums to be more sensitive, irritable and swollen ,

caries due to -vomitting , change in saliva and mouth flora

Question 17

what are the hygiene standard that needs tone taken care of for mammary glands

Answer 17

good hygiene of mammary glands mandatory - wash with water and soap regularly , massaging it can help develop glandular parenchyma

Question 18

if there is inverted nipples you should not stimulate it a lot to make it flatter why ?

Answer 18

nipples can cause increased uterine contractions - thus careful in women with predisposition to misscarriage or premature delivery

Question 19

why are flu vaccination recommenced in pregnant women

Answer 19

flu can be dangerous in early embryogenesis

Question 20

what is the normal average weight gain in pregnant women

Answer 20

a gain in 9-12 kg

Question 21

eating well and this weight gain in pregnancy ensures what ?

Answer 21

ensures the normal development if the fetus which grows 400-500g per week especially during 2nd half of pregnancy

Question 22

if the women tries to fight this weight gain what can it lead to ?

Answer 22

this will lead to malnutrition - giving low birth weight

Question 23

during the whole pregnancy women are supposed to have additional how many calories

Answer 23

additional 80,000kcal whole gestation, approx 300kc per day

Question 24

women’s diet should ensure which key elements ?

Answer 24

vitb12 and folic acid enough fruit and vegetables

folic aid - 4 weeks prior to conception to 12 weeks of gestation - decrease in rural tube defects

Question 25

what types of food should be avoided in pregnancy?

Answer 25

spicy food , fat food , fried food and burnt food should be minimised

Question 26

at the end of pregnancy protein intake increases to ?

Answer 26

70-80g daily

Question 27

deficiency in protein intake can lead to?

Answer 27

damage of the CNS of fetus

Question 28

what are the methods for estimating gestational age ?

Answer 28

LMP is the most reliable parameter for estimation of gestational age

calculate due date

Date of fruitful coitus 266 days are to be added to the date of the single fruitful coitus

Naegele’s formula: Provided the periods are regular
Add seven days to the first day of your LMP and then subtract three months

or adding 9 calender months and 7 days to the last day of LMP

==========
the US is the best

first trimester
US : crown rump length
CRL in cm + 6.5 = weeks of pregnancy
Gestation sac mean diameter — ( 5-7 weeks weeks formed)

2nd trimester
US : BPD, HC, AC and FL measurement. Most accurate when done between 12 and 20
weeks (variation ± 8 days)

3rd trimester
same as US in 2nd - however less reliable
variation ± 16 days

===============

Lightening- when the baby’s head literally “drops” lower into your pelvis = labor is likely to commence within 3 weeks

SFH

Question 29

what is SFH ?

Answer 29

symphysis to fundal height

Question 30

SFH used particularly in what period ?

Answer 30

after 24 weeks of gestation

Question 31

discrepancy of SFH to gestational age needs to be how many cm ?

Answer 31

3cm

Question 32

discrepancy of more 3cm in SFH is due to ?

Answer 32

fetus with growth problems , abnormal amniotic fluid , transverse lie , twin pregnancy ,uterine fibroid

Question 33

when does SFH become unreliable ?

Answer 33

unreliable due to maternal obesity , twin pregnancy , polyhydromnios, or uterine leiyomyomas

Question 34

when does does the CRL need to be replaced with head circumference value for age estimation ?

Answer 34

if CRL is above 8.4 cm - use head circumference value

compare these with standardised tables which correlate gestational week to CRL/ head circumference

Question 35

what method is used estimating the weight of the baby ?

Answer 35

johnsons formula 
155 x (fundal height in cm - K)
k= 11 if at plus station
k= 12 if to 0 station 
k = 13 if at minus station

applicable only in vertex presentation.
liquor amnii and thickness of the abdominal wall also plays a role

===========
US - better
Shepard and hadlock formula

Question 36

what are the following parameters needed to use the shepard and haddock formula ?

Answer 36

with the help of ultrasound

biparietal diameter
head circumference
abdominal circumference
femur length

Question 37

what are he immunisations recommended n pregnancy ?

Answer 37

routine tetanus toxoid and flu vaccine

LIVE VIRUS SUCH AS RUBELLA , MUMMPS , VARICELLA AND YELLOW FEVER, hep b, polio = are usually avoided even though there is no evidence having these vaccines causes birth defects so they can be used in pregency if there very high risk of getting infected

get MMR (mumps and rubella vaccine before pregnancy ) and hepatitis vaccine in a non immune woman offered

Question 38

what are the minor ailments during pregnancy ?

Answer 38

backache due to
joint ligament laxity (relaxin, estrogen), weight gain, hyperlordosis and anterior tilt of the pelvis

Heartburn is common in pregnancy due to relaxation of the esophageal sphincter.

leg cramps - deficiency of diffusible serum calcium or elevation of serum phosphorus. Supplementary calcium therapy in tablet or syrup after the principal meals may be effective. Massaging the leg, application of local heat and intake of vitamin B1

varicose vein - no blood return due the enlarged uterus
elastic crepe bandage
elevation of limbs

carpel tunnel syndrome - compression the median nerve leading to pain and numbessof the thumb and index and middle finger

round ligament pain - stretching of round ligament during moving in pregnancy cause sharp pain to the groin