VISITS AND EXAMINATION OF PRENANCY

VISITS AND EXAMINATIONS OF PREGNANCY

When should return visits be scheduled and what should each visit include?
· Every 4 weeks until 28 weeks. Screening: Urinary tract infection, proteinuria, preterm labor, gestational diabetes, and fetal well-being .

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· Every 2 weeks until 36 weeks. Screening: All of the above plus fetal growth. At 36 weeks, screening for reproductive infections: Chlamydia, gonorrhea and group hemolytic streptococcus.
· Every week until 41 weeks. Screening: All of the above, fetal well-being.
How is maternal condition evaluated at each visit?
· Blood pressure: Actual and any change or trend
· Weight: Actual and trend
· Symptoms: Headache, vision, pain, nausea, vomiting, bleeding, dysuria, loss of fluid, and uterus contractions.
· Vaginal examination if indicated.
How is fetal condition evaluated at each visit?
Fundus [the top upper part of the womb] of uterine height [to access growth]: Actual and trend
Fetal heart rate
Presenting part
Fetal activity or movement
Amniotic fluid if indicated.
What are the height of fundus on abdominal wall?
Duration of pregnancy as indicated by the height of the fundus::
The fundus [top of the womb] is palpable just above symphysis [pubic arch] at 8-10 weeks
It is halfway between symphysis and the umbilicus at 16 weeks
At the level with umbilicus at 20-22 weeks
At the halfway of umbilicus and epigastrium [mid-top of abdominal wall] at 28 weeks
Highest level near epigastrium at 36 weeks.
About one inch below the highest level at 40 weeks.
What are the length and weight of fetal or infant growth during pregnancy?

Table : Fetal growth by weeks,
length and weight
===========================
Pregnancy...Crown-heel…Weight
[weeks]…....length: cm….gm
…………….[approx.]…...[approx]
----------------------------------------------
4…………..0.4………….....0.4
8…………..3.5………….....2.0
12………...11.5………......19
16………...19………......100
20………...22………....300
24………...32………....600
28………...36………...1100
32………...41………...1800
36………...46…….....2200
40………...52…….....3200
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Source: Ralph C. Benson. OBSTETRICS AND GYNECOLOGY
Oregon, 1971, p 68-69.

Weight control during pregnancy:
What is the recommended total weight gain during pregnancy?
Approximately 12 kg
For under weight women, slightly more;
For overweight women, less.