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اي شي عشوائي يفيد ✌️ اي شي تحبون تشاركوه مع او بدون اسم @dohayarub ادعوا لي و للادمن البنات بالتوفيق
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507
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507
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
507
💎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
507
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
