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Gestational age
Calculated from LMP
Gestational age: 280 days or 40 weeks
Naegel formula : LMP = 10-6-1999
EDD = 17-3-2000
Trimester : represent period of 3 months
3
First visit
As soon as the period is late:
Anamnesis
Physical examination
Obstetrics examination
Supporting examination (USG)
Lab. test
Objective: obtain base line data.
4
Advices
See the doctor in following conditions:
Vaginal bleeding, oedema, headache,
blurred vision, abdominal pain,
excessive vomits, fever, dysuria, and
vaginal discharge.
Sebsequent visits
Every 4 weeks until 28 weeks of GA
Every 2 weeks until 36 weeks of GA
Every week until delivery
Monitor
Mother: weight gain, blood pressure,
anemia, fundal height, subjective
complains
Fetus: EFW (estimated fetal weight), lie,
presentation, single/ twin, movement, FHR
(fetal heart rate)
Lab: Hb, urine, TORCH etc
At week 36th (primigravida): bimanual
examination
2. Protein :
3. Mineral :
4. Vitamin:
Sexual activity
As needed
Abstinence when:
1. History of habitual abortion
2. Vaginal bleeding
3. Partus prematurus imminens
4. Rupture of the membrane
5. Dilatation of cervix
10
Highly Teratogenic
Talidomide
Anti
tumor drugs
Hormones (corticosteroid, androgen,
progestogen)
Valproat (anticonvulsan)
Isotretionin
12
agent (chlorambucyl,
cyclophosphamyde, busulfan etc)
Anti metabolit (e.g. aminopterin,
metotreksat)
Alkaloid (vincristin, vinblastin)
Antibiotika (actinomysin D)
MTX (methotrexate): highly
teratogenic
13
Hormone
Cortison
: platoschisis
Androgen and progestin: virilisation
of female fetus
Estrogen: clear cell adenocarcinoma
14
Anticonvulsant
Phenytoin, trimetadion, and
carbamazepin
Anomaly: labioschisis, palatoschisis,
mental retardation, gingiva
hypertrophy, and sceletal anomaly.
15
Cigarete (nicotine)
Increase the incidence of abortus
and premature labor
Increase the incidence of low birth
weight baby.
Congenital anomaly: congenital
heart disease such as tetralogi Fallot
and patent ductus arteriosus.
16
Alcohol (chronic)
Microsephal, palatoschisis
Cardiovascular disorder
Intra uterine growth retardation
Mental retardation
17
Antimalaria
Quinine:
Tetracyclin
Trimester I, bone growth disorder,
micromelia and syndactili.
Trimester II, yellow teeth and enamel
hipoplasia. (but no disturbance of
the strength or resistance of caries)
19
Aminoglicoside
streptomycin, kanamycin,
gentamycin and vancomycin.
Eight nerve and labyrinth (congenital
deafness) disorder
20
Vaccine
Vaccination
in trimester I, increase
the abortus risk
Vaccine rubella is prohibited during
pregnancy and two month before
pregnancy
21