Normal Pregnancy

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Normal Pregnancy
CAPT Mike Hughey, MC, USNR
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Symptoms of Pregnancy

• Nausea (1st TM)
• Breast and nipple tenderness (1st TM)
• Marked fatigue (1st 3rd TM)
• Urinary frequency (1st 3rd TM)
• Patient thinks shes pregnant

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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.

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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.

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Routine Visits

• Q4 weeks until 28 weeks
• Q2 weeks, 28-36 weeks
• Q week, 36-delivery

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Routine Visits

• At each visit

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Urine Test for Protein and Glucose

• Protein may indicate pre-eclampsia
• Glucose may indicate gestational diabetes

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Estimating Gestational Age

• LMP plus 280 days
• Add 7 days, subtract 3 months
• MacDonald's Rule (cm weeks)

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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

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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 dont
  need extra vitamins
• No one has a normal balanced diet.

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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

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Subsequent Laboratory Tests

• Amniocentesis at 11-17 weeks for women gt35
• 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

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Skin Changes

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

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Exercise During Pregnancy

• Balance
• Joint changes
• Heat
• Increased cardiac output

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Nausea Vomiting

• Common up to 16 weeks
• If she cant 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

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Heartburn

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

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Sciatica

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

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Sciatica

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

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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

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Upper Respiratory Infection

• Acetaminaphen - OK
• Guaifenisin - OK
• Pseudoephedrine - OK in 2nd TM
• Triprolidine - OK
• Penicillins - OK
• Cephalosporins - OK
• Erythromycin - OK

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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

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Thermal Stress During Pregnancy

• Avoid elevation of core temperature
• Mess decks
• Engine room spaces
• Laundry

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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.

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Low Frequency Whole Body Vibration

• Avoid it if possible

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Chemical Exposure During Pregnancy
Avoid

• Organic solvents
• Fuel oils
• Paint thinners
• Mercury
• Lead
• Cadmium

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Radiation Exposure During Pregnancy

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

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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

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Aircrew Status

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

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