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Calculating the Expected Date of Delivery (E.D.D.) 1 страница
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Calculating the Expected Date of Delivery (E. D. D. )
The dates of last period, height of the uterus, quickening are of great significance for determination of the term.
Calculating is based on the last menstrual period. It is easier to calculate by the following formula: the first day of the last menstrual period minus 3 calendar months plus 7 days = estimated date of delivery (E. D. D. )
Calculating is based on the coitus: single separate coitus + 275 days.
Calculating is based on the first fetal movement: i. e., quickening which appears in primigravida at term of 20 weeks of pregnancy, in patients who had any deliveries- at term of 18 weeks of gestation.
Calculating by special formulas
Skulsky’s formula: Х = (L х 2) — 5/5,
where X — term of pregnancy (in moons); L — the fetal length measured with pelvimeter; 2 — a doubling coefficient; 5 (numerator) — thickness of uterine walls; 5 (denominator) — Gaase’ coefficient.
Jordania‘s formula: Х = L + C,
where X — term of pregnancy (in moons); L — the fetal length measured with pelvimeter; C — fronto-occipital diameter of the fetal head (in cm), measured with pelvimeter.
Calculating is based on size of uterus.
The increase in size of the uterus can be assessed by the 5-6th week of gestation. The uterus first grows in antero-posterior direction and becomes more like a sphere; later it grows in a transverse direction as well. By the end of the second obstetrical month (8 weeks) the uterus grows to the size of a goose egg; by the end of the third month (12 weeks) the uterine fundus rises to the level of symphysis pubis. It should be remembered that one obstetrical month amounts 4 weeks. At the end of the 4th obstetrical month (16 weeks) one can find the fundus of the uterus in the middle between the symphysis pubis and the umbilicus, 8 cm above the pubis. At the end of the 5th month (20 weeks) the fundus of the uterus can be found 11-12 cm above the pubis, or 4 cm below the umbilicus. At the end of 6th month (24 weeks) the fundus of the uterus is on the level of the umbilicus, or 22-24 cm above the pubis. At the end of the 7th month (28 weeks) — is about 3-4 cm above the umbilicus. At the end of the 8th month (32 weeks) the fundus of the uterus is in the middle between the umbilicus and sternum, the umbilicus is flattened; the abdominal circumference is about 80-85 cm. At the end of the 9th month (36 weeks) the fundus of the uterus is on the line of ribs, abdominal circumference is about 90 cm. The umbilicus is absolutely flat. The abdominal circumference is about 90 cm. At the end of the 10th month (40 weeks) the fundus of the uterus is in the middle between the umbilicus and sternum, as it was in 32 weeks; the abdominal circumference — 95-100 cm. The umbilicus is everted. The head of the fetus is usually pressed to the pelvic brim in nulliparae, and ballotable in multiparae.
Self-Test
1. Which of the following signs or symptoms are not present in a 12-week pregnancy?
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A. quickening
B. ultrasonographic fetal heart action
C. amenorrhea
D. Hegar’s sign
2. Piskacek’s sign means:
A. asymmetrical enlargement of the uterine body
B. softening of the isthmic area
C. changeability of the uterus consistency
D. the increased mobility of the cervix
E. positive HCG-test
3. An X-ray examination is one of the most frequent types of obstetric examination nowadays.
A. yes
B. no
4. Identify the term when auscultation of the fetal heart sounds is possible:
A. 10-12 weeks
B. 16-17 weeks
C. 24 weeks
D. 6-7 weeks
E. at any time of gestation
5. Snegiryov’s sign means:
A. marked changeability of the uterus consistency during bimanual examination
B. enlargement of the uterus due to implantation of the fertilized ovum
C. vomiting and pain in the lower abdomen
D. asymmetrical uterine body
E. amenorrhea
6. True signs of pregnancy include the following, except for:
A. palpation of the fetal parts
B. evidently audible fetal heart sounds
C. active movements of the fetus felt by examiner
D. cardiography of the fetus
E. quickening
7. Quickening is usually felt at about 20th week
A. in nullipara
B. in multipara
8. Quickening is usually felt at about 18th week
A. nullipara
B. in multipara
9. Identify the term when fetal heart sounds may be heard:
A. 18-20 weeks of gestation
B. 30-32 weeks of gestation
C. 12-14 weeks of gestation
D. at term
10. Breast discomfort is:
A. a questionable sign of pregnancy
B. a probable sing of pregnancy
C. a true sign of pregnancy
Chapter 12. Hygienic Regimen and dietetics of pregnant
Hygiene of Woman during Pregnancy
From the moment of impregnation the numerous changes take place in a woman’s organism influencing the function of all organs and systems and primarily the endocrine apparatus. During pregnancy all organs function normally, but with increased exertion. Changes taking place in a woman’s organism in the course of pregnancy should be considered as mobilization of all resources of organism. However, physiological and pathological processes here are so close that frequently physiological processes quite unnoticeably pass to pathological ones. Therefore every expectant mother requires special supervision and attention from the very beginning of pregnancy. More strict observance of rules of personal hygiene is necessary, as well as shoe, clothes, nutrition, physical training, work, sex, etc. hygiene.
A healthy woman usually carries pregnancy easily, but at non-observance of rules of nutrition, hygienical requirements, on overstrain and at presence of other unfavorable factors the functions of organism can be disturbed, resulting in different complications.
In the general complex of hygienical measures, taking a shower, bath and a rubdown are of great importance. Hydrotherapeutic procedures must be carried out in combination with a hygienic gymnastics, sun-baths and air-baths.
The hygienic body care is a necessary condition for normal activity of not only skin but the whole organism as well. For a pregnant the cleanness of the body is of a particular significance, because the skin function increases, it accelerates the role of secretory organs facilitating the work of kidneys. The pregnant must regularly take a shower. It is recommended daily to rub a body with a towel moistened in water of a room temperature. It is particularly important to follow the oral hygiene and state of teeth. It is necessary to clean teeth in the morning and in the evening at bedtime and after taking food, and to rinse out mouth with warm water. Caries of teeth must be treated during pregnancy that serves as prophylaxis of after birth septic complications. The obligatory hygienic procedures should be shaving the armpits and their daily washing with warm water and soap. It should be done because in armpits, along with saprophytes, the pathogenic forms of microbes and fungi can grow.
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It is necessary to wash the external genital organs by warm water with soap 1-2 times a day. Previously hands should be washed. Washing is made from front towards back, from symphysis pubis to the region of anus (to the coccyx). Inflammatory processes can cause serious complications at births and in postnatal period. During pregnancy vaginal syringing is not recommended.
A pregnant woman is recommended to wash daily the mammary glands and nipples by water of a room temperature with soap, and then to dry them by clean coarse towel. After that the nipples are massaged with boric vaseline or sterile oil. Usually this is sufficient to prepare mammary glands for their future function. Nipples become hardened and vaseline softens the skin and makes it elastic. It is one of the prevention measures against cracks of nipples in after birth period and development of mastitis. If nipples are flat or pulled in, it is recommended to massage them by fingers 2-3 times a day for 3-4 minutes. For this purpose it is necessary to take the nipple, preliminary smeared with vaseline or child's cream, by index and large fingers and try to pull it out (to draw outwards) for several times. The massage of nipples is done during the last 2 months of pregnancy.
If pregnancy proceeds normally, a woman does not have to change the ordinary lifestyle. A pregnant must be engaged in ordinary work, alternating manual and mental labour. During pregnancy weight-lifting, jerky movements are prohibited. According to legislation, a woman from the moment of establishing her pregnancy is freed from work in the night-time and from overwork beginning with the end of the 4th month of pregnancy.
The duration of night sleep of pregnant should make up not less than 8 hours. Before going to bed it is recommended to go for a walk in the fresh air and to ventilate the room. Walks have a favourable effect on physical and mental condition of a woman, prenatal development of fetus, therefore a pregnant have to spend enough time in the fresh air. However, walks should not be tiresome for woman.
Air and sun-baths are allowed to a healthy pregnant. The duration of air-baths should be at the beginning not more than 5-10 minutes; as far as organism becomes hardened they are prolonged up to 15-20 minutes at air temperature of 20-22º C. Sun-baths are administered taking into account the state of the nervous, cardiovascular and other systems of organism. Ultraviolet irradiation is recommended in autumn-winter time. Bathing in the sea is allowed, if pregnancy develops normally. Bathing is preferable in warm weather; sunbathing of pregnant is not permitted.
A pregnant should beware of flu and other infectious diseases, because they can present a serious threat for the health of mother and fetus. Alcohol and smoking are forbidden. Sexual life should be limited during pregnancy, especially during the first 2-3 months. During the last 2 months of pregnancy intercourse is not recommended, because it can cause pathogenic microflora infection in the genital tract of woman.
A pregnant should wear comfortable loose clothes, not restraining motions. It is necessary to avoid compression of thorax and stomach, especially in the second half of pregnancy. With the purpose of diminishing the stagnant phenomena in the lower extremities, especially at varicosity, it is not recommended to be in a vertical position for a long time. Women working in a standing position are transferred to sedentary work. In case of varicosity, apart from special therapy, in the morning before getting up the circular elastic bandages on the legs or elastic stockings are put on.
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For prevention of overdistension of the front abdominal wall, a bandage is recommended from the 7-8th month of pregnancy which is applied in a lying position.
Shoes must be comfortable, wide-heeled.
Nutrition of pregnant
Already in the early terms pregnancy results in alteration of hormonal, ionic and other correlations. In the organism of pregnant all metabolic processes proceed differently.
For the normal course of pregnancy and valuable internal development of fetus the nutrition of pregnant is of great significance. It should be rational and to a certain extent individualized, in accordance with home conditions and features of woman’s organism. Four meals a day are recommended, especially in the first half of pregnancy. Breakfast should contain 25-30% of daily amount of calories, lunch — 10-15%, dinner — 40-50%, supper — 15-20%. More frequent nutrition is recommended during the last months of pregnancy, up to 5-6 times a day, by small portions. During pregnancy quite often in the early terms of pregnancy nausea, perversion of taste, sometimes vomiting in the mornings are observed. Usually these phenomena disappear from the 3-4th month. Some special diet at the beginning of pregnancy is not required. A woman should not limit herself in those products which she has eaten before pregnancy. Food must contain all the necessary nutritives, it is of importance.
There is a rapid growth of fetus in the second half of pregnancy; the functional loading on major organs increases, therefore more strict requirements should be set for a diet. Nutrition should be balanced, taking into account the physiological features of mother’s and fetus’ organism, thus it is necessary to follow the supposed body mass of fetus and predict the degree of correspondence of fetus’ size and mother’s pelvis. In the second half of pregnancy it is necessary to follow mainly milk-vegetable diet; meat and fish dishes are not forbidden, but their intake should be limited. Milk, curdled milk, kefir, curd, sour cream, butter, vegetable dishes, potato, porridges must prevail on the menu. Raw fruit, berries, vegetables are very useful, as they contain a lot of vitamins necessary for the health of both pregnant and developing fetus. In the second half of pregnancy it is necessary to eat meat 2-3 times a week; fish, especially boiled, can be eaten more frequently; soups with meat — 1-2 times a week. On other days of the week meat and fish soups are replaced by vegetable and milk ones. The additional amount of proteins of an animal origin can be taken with curd, eggs, cheese and milk products. Liquid should be limited up to 4-5 glasses a day. Salt and spicy food is not recommended. Pepper, mustard, vinegar, horse-radish and other spicy substances, spirits (vodka, wine, beer) are forbidden, because of their harmful influence on mother’s organism and on the major organs of fetus (alcohol quickly passes through the placenta and negatively affects fetus). The indicated limitations of a diet are necessary to prevent the dysfunctions of liver, kidneys and other organs.
Pregnant women are usually predisposed to constipations. In such cases sour milk or one-day kefir (200 g) are recommended at bedtime, and on empty stomach — raw vegetables, fruit (100-150 g of prunes, apples, raw carrot), whereupon breakfast should be started not immediately, but in 20-30 minutes. Usually the correct nutrition eliminates constipation. In extreme cases enemas are given.
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The organism of mother and fetus should get sufficient amount of proteins, fats, carbohydrates, mineral salts and vitamins.
Proteins. From the first months of pregnancy the organism feels an increased necessity in proteins, therefore it is necessary to provide a sufficient amount of valuable proteins in a food ration. Both quantity and quality of proteins are of great importance. Inadequate nutrition of pregnant results in hypoproteinemia, disturbances of the major physiological processes. An especially large necessity in proteins occurs in the second half of pregnancy, when there is a stormy growth and development of fetus. The full value of protein is determined by presence of essential amino acids in it. An average daily norm of protein in the first half of pregnancy makes up 1. 5 g/kg of body mass, in the second half — 2 g/kg. Proteins are introduced into organism in amount of 100-130 g a day. The following is recommended: kefir, curdled milk, and eggs (from 0. 3 to 1-1. 2 l/ d), meat (120-200 g), fish (150-250 g).
Fats. It is necessary for pregnant to take 100-110 g of fats a day mainly as butter, sour cream, cream and vegetable oils. Fats are needed not only as a power but also as a plastic material; the physiological norm of fats in relation to protein makes up 1: 1, i. e. on average 100 g. In the second half of pregnancy the amount of fats in food should be decreased.
Carbohydrates. In organism the basic source of fat formation is carbohydrates; their physiological norm in relation to proteins makes up 5: 1, i. e. not more than 500 g/d. At surplus mass of pregnant the amount of carbohydrates should be decreased up to 300-400 g/d. Porridges, bread, fruit, berries, vegetables are recommended.
Salt (mineral) exchange. Salts are required for proper prenatal development of fetus, normal formation of its skeleton, major organs and systems. The most essential among them are salts of sodium, calcium, potassium, magnesium, iron, phosphorus and others.
Common salt (sodium chloride) is limited in the second half of pregnancy up to 5 g/d, while an average daily norm makes up 12-15 g. It is connected with properties of common salt to retain water.
Liquid (water, fruit compote, tea, juice, milk, kissel) at the beginning of pregnancy is not limited. Daily it is possible to drink up to 2 l of liquid. In the second half of pregnancy its intake is limited to 1-1. 2 l, and during the last weeks — up to 0. 7-0. 8 l a day. It is due to the fact that by the end of pregnancy women quite often experience thirst and drink too much, that causes the development of edema. Therefore, salty, spicy dishes which cause large consumption of water are forbidden.
Calcium. During pregnancy teeth deteriorate in some women. They lose hardness, easily break and have a tendency to development of caries. Sometimes women have strong desire to eat lime, chalk, salt, etc. Such phenomena are explained by requirement of calcium salts in organism and it is necessary to change the diet, adding calcium, vitamin D, iron, phosphorus and quartz irradiation. It should be remembered that calcium consumption especially increases in the second half of pregnancy (calcium is used for formation of skeleton and soft tissues of fetus). Calcium is contained in cheese, egg yolks, milk. The consumption of milk in amount of 0. 8 to 1-1. 2 l/d usually fully satisfies the requirements of pregnant in calcium and phosphorus. A daily dose of calcium in the first half of pregnancy is 1 g, subsequently — 1. 5 g, and at the end of pregnancy — 2. 5 g a day. In the second half of pregnancy it is recommended additionally to give calcium as glycerophosphate (0. 3 g 3 times a day).
Phosphorus. It is expended for formation of fetus’ skeleton, its nervous tissue. Phosphorus is contained in large amount in nuts, bread, milk, meat, liver. A daily dose of phosphorus is 2 g.
Magnesium, iron, cobalt. Magnesium is of great significance for normal activity of cardiovascular and other systems of organism. It is contained in buckwheat, barley groats, saltwater fish. Day's necessity of magnesium is 0. 3 g, in the second half of pregnancy — 0. 5 g. Day's norm of iron for pregnant must make up not less than 15-20 mg. Cobalt is a component of vitamin B12. Beet, pea, strawberry, red currant, are the sources of cobalt.
Vitamins. Vitamins are biocatalysts regulating the functions of many organs and systems of a human organism. Vitamins are of particular importance for the organism of pregnant, as the normal course of pregnancy, growth of fetus and its further development largely depend on sufficient receipt of vitamins, above all vitamin C. The requirement of vitamins during pregnancy increases. Due to insufficient receipt of vitamins with food hypo- and even avitaminosis can occur in pregnant.
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The information on average daily necessity of pregnant in some vitamins is given below.
Vitamin A (carotin). Its lack in food results in deceleration of growth, diseases of eyes, liver, intestine. Vitamin A is a good protective factor of epithelium of mucous membranes, it is important for prophylaxis of postnatal diseases. It is contained in the liver, kidneys, butter, milk, eggs, carrot, cod-liver oil, apricots and cheese.
A daily dose is 5, 000 IU (about 1. 5 mg). During the last 2 months of pregnancy a daily dose can be increased up to 10, 000-20, 000 IU. If necessary, vitamin A is administered to pregnant as preparations.
Vitamin B1 (thiamine). It participates in metabolism, especially that of carbohydrates, contributes to the correct course of metabolic processes in the nervous system, favors glycogen-forming function of the liver, together with vitamin C regulates water-salt metabolism. Lack of vitamin B1 in organism conduces to severe disease of the nervous system, atrophy of muscles, paralysis of hands and feet. Brewers' yeast, liver, kidneys, milk, egg yolks, rye and wheat bread are rich in vitamin B1. An average daily necessity of adult in vitamin B1 makes up 2-3 mg, and pregnant — not less than 10-20 mg.
Vitamin B2 (riboflavin). It takes part in iron exchange and favourably influences the function of the liver. Its lack in organism results in affection of eyes, skin, mucous membranes, as well as in delay of growth. Vitamin B2 is contained in yeasts, liver, kidneys, meat, eggs, milk and dairy products. It is of great significance for the normal course of pregnancy and birth. A daily dose of vitamin B2 in a diet of pregnant should make up not less than 1-3 mg.
Vitamin B6 (Pyridoxin). It is necessary for the proper course of carbohydrate and fatty metabolism. It is contained in bread made of flour of coarse grinding. A daily dose of this vitamin should be not less than 5 mg. Vitamin B6 is essential both for pregnant and fetus.
Vitamin B12 (cyanocobalamin). It participates in the formation of nucleic acids, favourably influences the function of the liver, nervous system. It is applied in treatment of anemia. The preparation produces a good medical effect. It is contained in buckwheat groats, yeasts, liver. A daily dose is 0. 003 mg.
Vitamin PP (nicotinic acid). It is of great importance in preserving the normal function of separate organs and systems. The organism needs it for metaboliс processes. Pellagra, i. e. damage of the central and peripheral nervous system develops due to lack of this vitamin. Pellagra affects skin and mucous membranes, dysfunction of intestine. Vitamin PP is contained in yeasts, rye bread, meat, liver, lungs, wheat grain, potato. An average daily need of expectant and nursing mother in this vitamin is 18-23 mg.
Vitamin C (ascorbic acid). It is indispensable for the normal course of pregnancy. It participates in oxidizing processes of organism, activates intracellular enzymatic processes. Lack of this vitamin in organism results in scurvy, and in pregnant, in addition, spontaneous abortions or premature birth can occur. Vitamin C is contained in many fruit, berries, vegetables. It is especially abundant in wild rose, blackberry, lemon, leek. A daily need of expectant and nursing mother in this vitamin is 100-200 mg. In the second half of pregnancy the necessity increases considerably. In a winter-spring period with a prophylactic purpose the expectant or feeding- nursing mother is administered ready-made preparations of vitamin C (drops, pills) or ascorbic acid with glucose (0. 5 g 3 times a day).
Vitamin E (tocopherol). It is of importance for the normal course of pregnancy, participates in a lipid metabolism, contributes to prevention of spontaneous abortions and premature birth. The lack of vitamin E in organism can result in dysfunction of sexual glands, and in pregnant — to death of fetus and abortion. Vitamin E is contained in germinating part of wheat and corn, eggs, liver, lettuce. It is used at treatment of spontaneous abortions (tocopherol in oily solution is administered in a dose of a teaspoonful 1-2 times a day). With a prophylactic purpose vitamin E is recommended to women who had spontaneous abortions and premature birth in the past. A daily dose of vitamin E for pregnant, instead of ordinary 10 mg, rises up to 20-25 mg and even more for those, who had spontaneous abortions and premature birth.
Vitamin D (antirickets). It takes an active part in regulation of calcium and phosphoric exchange, prevention of rachitis in fetus. It is contained in cod-liver oil, meat, fat sorts of fish, liver, and butter. At lack of this vitamin in organism cod-liver oil (1 tablespoonful 1-2 times a day) or vitaminol (from 10, 000 to 20, 000 IU) are administered. A daily need of expectant mother in vitamin D is 1, 000 IU.
Folic acid. Folate, formerly known as folacin, is the generic term for both naturally occurring food folate and folic acid, the fully oxidized monoglutamate form of the vitamin B (B9) that is used in dietary supplements and fortified foods. A B9 vitamin is important for cell growth and metabolism. Taking a prenatal vitamin with the recommended 400 to 800 micrograms (mcg) of folic acid before and during pregnancy helps prevent birth defects of baby's brain and spinal cord.
Exercise Therapy for Pregnant
During pregnancy regular exercise therapy is necessary, which promotes physical abilities of organism, creates a sense of cheerfulness, improves the common state, appetite, sleep, and also makes conditions for the normal course of pregnancy, thus assisting to a normal development of fetus. The systematic exercise therapy pursues the following aims: to improve the activity of the cardiovascular and nervous systems, respiratory organs, gastrointestinal tract, metabolism, to provide sufficient oxygen supply to mother and fetus, to teach a pregnant to correct breathing, to strengthen muscles of the abdominal wall and pelvic bottom, to remove the congestion phenomena in small pelvis and lower extremities. Special exercises at normal pregnancy are particularly useful for those women, who have mainly a sedentary, not mobile way of life.
These physical exercises can be recommended to all healthy pregnant from the first days of their visit to obstetrician. It is necessary to underline that physical training should be administered to pregnant in view of features of woman’s organism and those processes, which take place in it at developing pregnancy. Physical exercises should be done according to advice of a doctor, methodologist or person having a special medical preparation (midwife). Properly organized physical training is a good means both to strengthen the common physical health of a woman and to promote the prevention of weakness of childbirth. It is of particular importance to teach a pregnant to correctly breath, to develop diaphragmatic breathing facilitating in removing stagnant plethora in the organs of abdominal region.
Physical training is better to conduct in the morning time (1-1. 5 h after breakfast). A specially equipped premise is designed for it, with good ventilation and illumination (more often in maternity welfare clinic). Physical training classes for pregnant followed up in maternity welfare clinic may be conducted by two methods: in group and individually (at home). The latter method foresees visits of a pregnant every 10 days to a doctor in exercise therapy (methodologist), who exerts medical control and checks up accuracy of doing physical exercises.
Regular classes in physical therapy have a positive effect on both mother’s and fetus’ organism. It is marked that in women, having regular physical training during pregnancy, delivery is quick and easier, the amount of ruptures of perineum considerably diminishes, and postnatal period passes more safely. At the beginning physical exercises last not more than 15 minutes, later on pregnant are allowed to have physical exercises for 20 min, and at good state — up to 25-30 min. During the first 3-4 months of pregnancy, especially on days corresponding to menstruations, difficult exercises should be excluded. On administering physical training to pregnant one should be particularly careful in regard to those types of exercises which affect the muscular system and ligamentous apparatus of the internal genital organs. There is no need to fulfill the whole complex of exercises every time. It is necessary to take into account the common state of pregnant, to follow the correct breathing, indexes of arterial pressure and pulse.
The method of exercise therapy has been developed for pregnant by A. A. Lebedev and his colleagues; it is simple, not difficult for mastering and effective. On choosing exercises attention is paid to those ones, which develop the diaphragmatic breathing, strengthen the muscles of the stomach and perineum, participating actively in act of delivery. All exercises are divided into three basic complexes corresponding to motor potential of a woman’s organism in different terms of pregnancy: till 16 weeks, from 17 to 31 weeks and from 33 to 40 weeks of pregnancy.
Contraindication to physical training are: acute forms of cardiovascular diseases with blood circulation disorders, pulmonary tuberculosis in the phase of exacerbation, and at complication of pleurisy, etc., all acute inflammatory diseases (endometritis, thrombophlebitis, etc. ), diseases of kidneys and urinary bladder (nephritis, nephrosis, pyelocystitis), gestational toxicoses, bleeding during pregnancy, primary miscarriage. It should be remembered that even well-trained sportswomen should be very careful at physical training during pregnancy. Such women are banned from competitions, as apart from physical exertion the nervous overstrain occurs that can result in miscarriage.
Self Test
1. The hygienic care of the body is a necessary condition for the normal activity of the
A. skin
B. heart
C. legs
D. eyes
2. The necessity in proteins during pregnancy
A. increases
B. decreases
3. Salt should be limited in pregnancy up to:
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