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حطيتلكم ستكر ستج

ارقام محاضرة 7 هم لان تكرهوها (جذب اني اكرهها)

PHC-7 🔹Vaginal blood loss ≤250 mL ➡️ Normal postpartum bleeding ⸻ 🔹>2–3 pads in 20–30 min after delivery ➡️ Emergency bleeding 🚨 ➡️ Immediate hospital assessment ⸻ 🔹≥1 pad in 5 min within or after 6 weeks after delivery ➡️ Heavy vaginal bleeding / Postpartum hemorrhage (PPH) 🚨 ➡️ Urgent hospital referral ⸻ 🔹<1 pad in 5 min after 6 weeks ➡️ Light vaginal bleeding ➡️ Refer to hospital for assessment ⸻ 🔹Fever >38°C + weakness + lower abdominal pain + tenderness + foul-smelling lochia + profuse lochia + uterus not well contracted + history of heavy vaginal bleeding ➡️ Uterine infection ➡️ Give first dose IV/IM antibiotics ➡️ Urgent hospital referral 🚨 ⸻ 🔹Fever >38°C + burning on urination + flank pain ➡️ Upper urinary tract infection ➡️ Give first dose IV/IM antibiotics ➡️ Urgent hospital referral 🚨 ⸻ 🔹Burning on urination + suprapubic pain + urinary frequency ➡️ Lower urinary tract infection ➡️ Give amoxicillin ➡️ Encourage fluids ➡️ Follow-up after 2 days ➡️ Refer if no improvement ⸻ 🔹Fever >38°C + stiff neck or lethargy ➡️ Very severe febrile disease ➡️ Give first dose IV/IM antibiotics ➡️ Urgent hospital referral 🚨 ⸻ 🔹Diastolic BP >110 mmHg ➡️ Preeclampsia ➡️ Start antihypertensive therapy ➡️ Urgent hospital referral 🚨 ⸻ 🔹Diastolic BP >90 mmHg on two readings ➡️ Preeclampsia ➡️ Reassess after 1 week ➡️ Refer if persistent ⸻ 🔹Target BP <140/90 mmHg ➡️ Aim during treatment of hypertensive disorders ⸻ 🔹BMI ≥30 or ≥35 ➡️ Obesity ➡️ Early mobilization ➡️ Compression stockings if ≥2 thromboembolism risk factors ➡️ Breastfeeding counselling ➡️ Glucose tolerance test at 6 weeks postpartum ➡️ Dietitian referral ⸻ 🔹BMI ≥40 ➡️ Severe obesity ➡️ Apply all above measures ➡️ Refer for thromboprophylaxis 🚨 ⸻ 🔹1st postnatal contact → 24–48 hr after delivery 🔹2nd postnatal contact → 72 hr after delivery 🔹3rd postnatal contact → 7–14 days after delivery 🔹4th postnatal contact → 6 weeks after delivery (42 days) 🔹Postnatal period → 6 weeks = 42 days 🔹Iron + folic acid → 3 months postpartum 🔹Change pads → every 4–6 hr 🔹Sexual health/dyspareunia assessment → 2–6 weeks postpartum 🔹Avoid intercourse → until vaginal bleeding stops + perineal wound heals 🔹Pregnancy can occur → 4 weeks after delivery 🔹Pregnancy can occur → 2 weeks after abortion 🔹Recommended spacing after delivery → ≥24 months 🔹Recommended spacing after abortion → ≥6 months 🔹LAM* works if: 🪽│ Exclusive breastfeeding Baby <6 months 🪽│ No menses 🔹Exclusive breastfeeding → 6 months 🔹Postnatal blues → first week, lasts up to 2 weeks 🔹Postpartum depression → lasts at least 2 weeks 🔹Gestational diabetes follow-up → fasting plasma glucose at 6–13 weeks or HbA1c 🔹If normal → annual HbA1c screening *LAM = Lactational Amenorrhea Method

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PHC-6 كل الارقام درخوها 💎 Routine antenatal care visits: 🔹 1st visit → first 12 weeks 🔹 2nd visit → 18 weeks 🔹 3rd visit → 24 weeks 🔹 4th visit → 28 weeks 🔹 5th visit → 32 weeks 🔹 6th visit → 36 weeks 🔹 7th visit → 38 weeks 🔹 8th visit → 40 weeks 💎 Pregnancy confirmation: 🔹 Urine pregnancy test positive after 2–3 weeks 🔹 Around 10 days after first missed period 🔹 Uterus palpable after 13 weeks 💎 Gravidity and parity: 🔹 Delivery beyond 28 weeks = parity 🔹 Pregnancy terminated before 28 weeks = abortion 💎 Expected date of delivery: 🔹 Last menstrual period + 9 months + 7 days 💎 Ultrasound schedule: 🔹 10–14 weeks → determine gestational age + detect multiple pregnancy 🔹 18–22 weeks → fetal anomalies + placental location 🔹 31–33 weeks → fetal wellbeing + placental location 💎 Venous thromboembolism prophylaxis: 🔹 Total score ≥4 antenatally → thromboprophylaxis from first trimester 🔹 Total score 3 antenatally → thromboprophylaxis from 28 weeks 🔹 Total score ≥2 postnatally → thromboprophylaxis for at least 10 days 🔹 Prolonged admission ≥3 days → thromboprophylaxis 💎 Gestational diabetes mellitus: 🔹 Screen all pregnant women at 24–28 weeks 🔹 Oral glucose tolerance test at 24–28 weeks 🔹 High-risk women screened at first antenatal visit 💎 Risk factors for gestational diabetes mellitus: 🔹 Age ≥25 years 🔹 Body mass index ≥30 kilograms/m² 💎 Severe hypertension: 🔹 Blood pressure ≥160/110 millimeters mercury → urgent same-day referral 💎 Pre-eclampsia: 🔹 New onset hypertension after 20 weeks 🔹 Blood pressure >140 systolic or >90 diastolic 🔹 Proteinuria: 🔹 ≥2+ on dipstick testing on one occasion 🔹 OR ≥1+ on dipstick testing on two occasions 🔹 Platelet count below 150,000 💎 Risk assessment for hypertensive disorders: 🔹 Age >40 years 🔹 Pregnancy interval >10 years 🔹 Body mass index >35 kilograms/m² 💎 Blood pressure reassessment: 🔹 Diastolic blood pressure ≥90 → repeat after 1 hour rest 💎 Fetal monitoring: 🔹 Start after 24 weeks 🔹 No more frequently than every 2 weeks 🔹 Fetal kick count = at least 10 movements in 2 hours 🔹 Absence of fetal movement may precede intrauterine fetal death by 48 hours 💎 Breech presentation: 🔹 Breech confirmed after 36+0 weeks → refer to obstetrician 💎 Fundal level growth: 🔹 Until 20 weeks → 2 finger breadths every 2 weeks 🔹 From 20 weeks to birth → 1 finger breadth every 2 weeks 💎 Anemia: 🔹 Complete blood count at first antenatal visit 🔹 Hemoglobin in following trimesters 🔹 Severe anemia follow-up → return in 2 weeks 💎 Iron and folic acid: 🔹 Folic acid supplementation during pregnancy 🔹 Iron supplementation during pregnancy 🔹 Anemia → iron and folic acid twice daily 💎 Tetanus-diphtheria vaccine: 🔹 Total target = 5 doses 🔹 Example: childhood 4 doses → pregnant woman needs 2 more doses 🔹First dose → after first trimester 🔹Second dose → after 1 year 💎 If no previous vaccine doses: 🔹Woman needs full 5 doses 💎 Anti-D immunoglobulin prophylaxis: 🔹28–30 weeks 💎 Follow-up visits: 🔹Hypertension after 8 months pregnancy → return in 1 week 🔹Severe anemia → return in 2 weeks 💎 Folic acid: 🔹Low-risk pregnant woman → 400 micrograms daily 🔹High-risk pregnant woman → 5 milligrams daily 💎 High-risk group: 🔹Previous baby with neural tube defect 🔹Family history of neural tube defect 🔹Diabetes mellitus 🔹Epilepsy treated with anticonvulsant drugs(valproate , carbamazepine) 🔹Body mass index more than 35 kilograms/m² 💎 Timing: 🔹Before conception until 12 weeks of pregnancy 💎 During 2nd and 3rd trimester: 🔹Give iron and folic acid supplementation during pregnancy 💎 Iron: 🔹60 milligrams elemental iron daily 💎 Anemia: 🔹Iron and folic acid twice daily 💎Counseling 3rd trimester 💎fetal movements 🔹Primi at 18 weeks 🔹Multi at 16 weeks 🔹At 36 weeks; Assessment of fetal size, lie, presentation. of pelvic capacity. 🔹Fetal movements: Absence (IUFD) 48 hours 🔹ask baby's movements at each antenatal contact after 24+0 weeks 💎fundus levels 🔹12 weeks→fundus just above pubic bone 🔹36–38 weeks→fundus usually right up under sternum 🔹40 weeks (term)→fundus drops below 38-week level as presenting part drops down into pelvis

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