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OBSTETRICS EXAMS / QUIZES / CASES / MCQ / FINALS

كتاب القسم + كتاب دكتور داليا + ZAG EXAMS https://t.me/watfapedia_major/3158 NORMAL PREGANACY https://t.me/watfapedia_major/3161 BLEEDING IN LATE PREGNANCY https://t.me/watfapedia_major/3168 AMNIOTIC FLUID ABNORMALITY https://t.me/watfapedia_major/3176 HTN ( MEDICAL DISORDER ) https://t.me/watfapedia_major/3186 DM + VOMITING + ANEMIA https://t.me/watfapedia_major/3195 FAMILY - ANC + PNC https://t.me/watfapedia_major/3207

https://t.me/Hemma54 وهمه برضو لما تخلصوا كل شابتر بصوا على ال keywords

ابقوا بصوا عليهم

Maternal Health care 1. Antenatal care Objectives : عبيد A →Assess health status including risk detection P→ Preventive health services P→ Provide referral services I→ Initiate plan for obstatric care D→ Determine gestational age of fetus Component: خادم S → Social care E →health Education R → Registration and Record keeping R →Risk detection R → Referral services V →home Visits V → periodic Visit A →Antenatal care N → Nutritional education and care T → Tetanus toxoid

دي بقي الارقام كلها لو حد بيهتم جدا بالتفاصيل

* Woman Health Card: Covers 3 pregnancies. * Minimum Recommended Visits: A minimum of 8 visits are required throughout the entire pregnancy period. * Home Visiting: Conducted for 2 main purposes.

## Visit Schedule

### Detailed Recommended Visit Schedule: * Up to 28 weeks of gestation: Visits every 4 weeks (total 7 visits). * From 28 to 36 weeks: Visits every 2 weeks (total 4 visits). * After 36 weeks: Visits every 1 week (total 4 visits until 42 weeks). ### Minimum Required Visit Schedule (Total 8 visits): * First visit: As early as possible in the first trimester (approximately between weeks 1 and 12). * Second and third visits: Between 20 and 26 weeks. * Fourth and fifth visits: Between 30 and 34 weeks. * Sixth and seventh visits: Between 36 and 38 weeks. * Eighth visit: At 40 weeks.

## Measurements and Assessments

* Blood Pressure: A reading of more than 140/90 is considered a risk factor requiring attention. * Fundal Height Measurement: Measured between 20 and 34 weeks. * Ultrasound Scan: At least one scan is recommended before 24 weeks of gestation. * Anemia Diagnosis: Diagnosed if the hemoglobin level is less than 11 g / 100 ml. * Caffeine Intake: Recommended to reduce daily intake exceeding 300 mg per day.

## Nutritional Supplements

### Iron and Folic Acid Supplements: * Routine daily dose of elemental iron: 30 mg to 60 mg. * Elemental iron equivalents (example for 60 mg): 300 mg ferrous sulfate hepahydrate, 180 mg ferrous fumarate, or 500 mg ferrous gluconate. * Routine folic acid dose: 400 micrograms (0.4 mg). * Folic acid dose for high-risk cases (for neural tube defects): 4 mg daily prior to conception and for the first 12 weeks. ### Calcium Supplements: * Recommended daily dose in populations with low dietary intake: 1.5**–**2.0 g oral elemental calcium daily after the first trimester.

## Vaccinations

* Tetanus Toxoid (TT) Vaccination: * If not previously vaccinated: The mother requires 2 doses. * The second dose: Given at least 4 weeks after the first dose, and must be at least two weeks before the expected date of delivery. * In subsequent pregnancies: The mother requires 1 booster dose. * Full immunization schedule (for long-term protection): TT1, TT2 (at least 4 weeks after TT1), TT3 (at least 6 months after TT2), TT4 (at least 1 year after TT3), TT5 (at least 1 year after TT4).

## Weight Gain During Pregnancy

* Weight gain is specifically assessed by the 20**th week. * Expected gain by **20 weeks: Approximately 3.5 kg. * Maximum allowed weekly gain after 20 weeks: 0.5 kg. * Total expected normal gain throughout the entire pregnancy: Between 9 and 11 kg.

أرقام شابتر ANC ▪️by 20w. Gestation >> gains 3.5 kg ▪️after 20w. Not allowed > .5kg/w (max) ▪️Total gain during preg. 9-11 kg ▪️Blood pressure >140/90 is a risk ▪️fundal height is done 20-34 w. ▪️early US < 24 w. ▪️high caffeine intake >300 mg/d ▪️anemic preg. Hb <11g/100ml ▪️daily oral doses of: ▫️elemental iron 30-60 mg ▫️folic acid .4 mg (400 ug) 🔺women é high risk of neural tubal defect takes 4mg .. before conception and 12w. Of preg. ▫️Ca++ 1.5-2 g in low dietary but after 1st trimester (decrease risk of preeclampsia)

دول تاثير الاستروجين لوحده والبروجيستيرون لوحده على كل system تجميعة لطيفة TBH هتحتاجها عشان متتوهش

دي كده تجميعة للهرمونات اللي جاية من المشيمة عشان هو قالك see before وخلع منك Placental Hormones and Their Effects:

1. **Human Chorionic Gonadotropin (hCG):**

* Detected in pregnancy tests. * Acts as an immunosuppressive agent to help prevent fetal rejection. * Contributes to the etiology of Hyperemesis Gravidarum.

2. **Estrogen:**

* Stimulates uterine hypertrophy early in pregnancy. * Increases vascularity and hyperemia in the cervix, vagina, and perineum (Chadwick sign). * Causes changes in vaginal walls in preparation for labor. * Increases vaginal glycogen production, leading to acidic pH and increased discharge (Leucorrhoea). * Contributes to salt and water retention. * Increases pigmentation (Linea nigra, Chloasma gravidarum, areola changes). * Increases plasma levels of prolactin. * Contributes to Epulis (gum hypertrophy and edema). * May contribute to headaches. * Contributes to insulin antagonism (diabetogenic effect).

3. **Progesterone:**

* Stimulates uterine hypertrophy early in pregnancy. * Stimulates production of copious, tenacious cervical mucus (operculum). * Decreases smooth muscle tone and motility throughout the GIT, leading to cardiac sphincter atony (reflux, heartburn), decreased gastric motility (dyspepsia), and decreased large intestine motility (constipation). * Causes Hyperventilation, potentially leading to Dyspnea. * Contributes to salt and water retention. * Decreases cell-mediated immunity and increases levels of immunosuppressive agents. * May contribute to headaches. * Contributes to the softening of pelvic joints and ligaments. * Contributes to insulin antagonism (diabetogenic effect).

4. **Human Placental Lactogen (hPL):**

* Acts as an insulin antagonist, contributing to the diabetogenic effect of pregnancy.

لو قولتلك ريكوردين ال ante partum hgr هينزلوا هترد ولا هتكلسن

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