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Medical management of normal pregnancy 

Medical management of normal pregnancy

Medical management of normal pregnancy

David J. Williams

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date: 28 April 2017

Reducing the number of maternal deaths is one of the United Nation’s eight Millennium Development Goals, yet despite this initiative maternal deaths are increasing in some parts of Africa, usually from readily preventable causes that would not occur in the presence of a skilled birth attendant.

Diagnosis of pregnancy—this can be achieved within a day of missing a menstrual bleed by identifying a rise in concentration of urinary human chorionic gonadotropin.

Antenatal checks—at the first antenatal visit a medical and obstetric history is combined with (1) cardiovascular examination; (2) urinalysis—proteinuria, bacteriuria; and (3) laboratory tests—HIV, hepatitis B, and syphilis; screening for sickle cell disease, thalassaemias, and rhesus antibodies. Further antenatal checks (obstetric, blood pressure, urinalysis) are usually performed around 16, 25, 28, 31, 34, 36, 38 and 40 weeks, then weekly until delivery.

Clinical features of pregnancy—aside from those obviously related to a growing fetus in the abdomen, symptoms of a healthy pregnancy include fatigue, palpitations, dizziness, syncope, dyspnoea, nausea, vomiting, headaches, and oedema, and signs include full and bounding arterial pulses and an ejection systolic flow murmur.

General management—pregnant women may require nutritional advice (see Chapter 14.2) and should be advised to take regular exercise, stop smoking, and avoid heavy alcohol consumption (but there is no evidence that 1 to 2 units of alcohol once or twice a week is harmful to the fetus).

Clinical priorities—when managing medical disorders in pregnancy, the clinician’s priority is to treat the maternal condition, sometimes at the risk of fetal well-being.

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