Signs of Pregnancy
Diagnosis of Pregnancy
Estimated Delivery Date
Gravidity and Parity
Screening Test – Quad Screen Test
Keys for pregnancy
Contraindicated Medications
Signs of Pregnancy
「P」で始まる単語 (distraction) が混じってたりする。「possible sign」とか。
Presumptive Signs – Subjective
- Absent of period (amenorrhea)
- Nausea/Vomiting
- Fatigue (esp. in the morning)
- Breast tenderness
- Breast bloating
- Movement of the fetus (again, subjective. Quickening is around 20 week for primigravida and around 16 weeks for multigravida.)
Probable Signs – “Probable” is not 100%
下の三つのサインは、早く起きる順に（CGH -> アルファベット順）
- Chadwick’s Sign (Blue-violet vaginal color)
- Goodell’s Sign (softening of vaginal portion of the cervix)
- Hegar’s Sign (softening of uterine isthmus)
- Braxton Hicks Contractions (false labor contractions)
- Fetus can be palpable, but not guaranteed, not 100%.
Positive Signs
- Ultrasound detect fetus
- Fetus heart sound is detected by Doppler
Diagnosis of Pregnancy
- Urine – not as sensitive as serum pregnancy test
- Serum pregnancy test – detect β-human chorionic gonadotropin (β-hCG)
- Ultrasound
Estimated Delivdery Date
The first day of the last normal menstrual period (LNMP)から数える。
教科書には、プラスマイナス何日云々書かれていますが、私はそこは捨てて、「40週後」でいきたいと思います（<-Cleveland Clinic Websiteより)。
Gravidity and Parity (GTPAL)
Gravidity – total number of pregnancy
Parity – means “uterus being empty”
(G) – total number of pregnancy, then -> TPAL – 4 numbers
(T) – number of term delivery (>37 weeks)
(P) – number of preterm delivery (20 – 36 6/7 weeks)
(A) – number of abortion (elective or spontaneous before 20 weeks)
(L) – number of living children
Quad Screen Test
「Quad Screen Test」＝ 妊娠４～５か月目くらいにある血液検査。
この血液検査は、「あくまでスクリーニング」であって、「診断」を下す「diagnostic test」ではありません。35歳以上の妊婦さんだけでなく、全員が対象。
その後に任意で受けられる「羊水検査/amniocentesis」=
「diagnostic test」。
「Cell free fetal DNA test」＝ 血液検査。胎児の血液が母体とつながっているので、母体経由で胎児のテストをします。
Quad Screen Test (Fitzgerald, 2015)
Some Keys for Pregnancy
Constipation – Bulking agents (psylllium (Soluble fiber – Metamucilとか), methycellulose (Citrucelとか）).
senna is OK for Constipation in Pregnancy but not daily-use –
NOT OK (Not approved by FDA for pregnancy) —>polyethylene glycol (Miralax)
Folic acid amount for healthy pregnant women ——— 0.4 mg (400 mcg)
Levothyroxine OK to use in pregnancy/lactation? ————- Yes, OK
How much Levothyroxine should be increased in the 1st trimester ————– 30%
Medication treatment for HTN ————— Low dose aspirin
N/V treatment in pregnancy ————— Vitamin B (pyridoxine) + antihistamine (eg. doxylamine)
When to test Group B streptococcus vaginal culture ———– 35-37 week, person wih Hx of GBS(+) – no need to screen, automatically ABT during labor.
Most birth defect period ———- the first 3 months (period of ograno-genesis/embryo-genesis) – 最重要時期 no medicine, no illegal drug, no alcohol, no infection
Acetaminophen – max daily dose – 3,000 mg
Contraindicated meds in pregnancy
NSAID (even diclofenac “topical” gel)
Glucosamine – no sufficient evidence for safety
Beta blockers – cross the placenta
Warfarin – cross the placenta
ABT – Bactrim, tetracyclines, aminoglycosides (i.g. gentamycin, tobramycin), metronidazole (controversial but better to be avoided in the 1st tri. & lactation. SJS rash risk), fluoroquinolones (i.g. levofloxacin, ciprofloxacin), nitrofurantoin (best to be avoided, especially in the 3rd trimester)
Live Vaccines – MMR, Varicella, Herpes zoster, live attenuated influenza (Nasal spray), Rotavirus.
Paroxetine (category D)
Doxycycline (category D)
Benzodiazepine (category D)
magnesium sulfate (category D) – 妊娠20週目の妊婦さんのasthma attackに使用された例（生死がかかっている場合にはcategory Dでもbenefit > riskということで）
magnesium citrate (category C) – laxatives, bowel prep for colonoscopy, not daily use
Cytotec (category X – absolutely contraindicated)
Accutane (category X – absolutely contraindicated)
finasteride (Propecia) (category X – absolutely contraindicated) – 脱毛用の薬。女性に使用できるのは、OK med = minoxidil (Rogaine)
Reference
Fitzgerald, M. A. (2015). Nurse Practitioner certification examination and practice preparation (4th ed.). F. A. Davis