· MCC sx? Amenorrhea
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Sign
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Physical Findings
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Time from conception
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Goodell sign
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Softening of the cervix
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4 weeks
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Ladin sign
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Softening of the midline of the uterus
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6 weeks
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Chadwick sign
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Blue discoloration of vagina and cervix
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6-8 weeks
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Telangiectasias/palmar erythema
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Small blood vessels/reddening of the palms
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1st trimester
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Chloasma
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The “mask of pregnancy” is a hyperpigmentation of the face most commonly on forehead, nose, and cheeks; it can worsen with sun exposure.
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16 weeks (2nd trimester)
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Linea nigra
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A line of hyperpigmentation that can extend from xiphoid process to pubic symphysis
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2nd trimester
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· How to dx pregnancy? Urine/Serum ß-hCG ➡ confirm w/ US.
· ß-hCG ⤴️until 10 weeks (doubles every 48h) then slowly ⤵️ in 2ndtrimester, then slowly ⤴️in 3rd trimester.
· Beta-HCG >1500 or 5 weeks = gestational sac on ultrasound
Physiologic changes
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Cardio
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· ⤴️ CO
· ⤴️ HR
· ⤵️ BP
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Resp
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· ⤴️ Tidal volume
· ⤵️ FRC
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GI
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· Morning Sickness
· Lower esophageal sphincter tone ⤵️ (GERD)
· Large intestine motility ⤵️ (Constipation)
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Renal
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· Dilation of both kidney & ureter (⤴️ risk for pyelo)
· ⤴️ GFR
· Hydronephrosis here is normal
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Hema
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· Anemia + hypercoagulable state (by ⤴️ in fibrenogen + venous stasis – other coagulation studies are ⓝ)
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Thyroid
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⤴️ Thyroid (to keep up w/ demand), by:
1. Estrogen → ⤴️ TBG → thyroid makes more hormones
2. ßhCG stimulates TSH Receptors (⤵️ TSH)
Total T4: ⤴️ / Free T4: Ⓝ / TSH: ⤵️
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Illicit drug abuse in pregnancy
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RF
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· Adolescent pregnancy
· Late/noncompliant prenatal care
· Inadequate pregnancy weight gain
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Comp
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· Spontaneous abortion
· Preterm birth
· Preeclampsia
· Abruptio placentae
· IUGR
· Fetal demise
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Vaccines during pregnancy
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Recommended
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· Tdap
· Inactivated influenza
· Rho(D)GAM
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Indicated for high-risk pts
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· Hepatitis B
· Hepatitis A
· Pneumococcus
· Haemophilus influenzae
· Meningococcus
· Varicella-zoster immunoglobulin
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Contraindicated
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HPV (live)
MMR
Live attenuated influenza
Varicella
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Pregnancy & Exercise
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Absolute Contraindications
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Amniotic fluid leak
Cervical incompetence
Multiple gestation
Placenta abruption or previa
Premature labor
Preeclampsia/gestational hypertension
Severe heart or lung disease
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Unsafe
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Contact sports (basketball, ice hockey, soccer)
High fall risk (eg, downhill skiing, gymnastics, horseback riding)
Scuba diving
Hot yoga
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Fast HY Review 