👮‍♂🖤 محاضرة Antenatal care متنسقة ومتضاف عليها اي ملاحظات قالها الدكتور في الشرح

👮🖤 🤰✨ Physiological Changes in Pregnancy ✨🤰 📌 أهم النقاط ————————————— 🌱 Introduction 👉 At 6–8 wk, the corpus luteum hands hormone production to the placenta 🔄 👉 Main hormone factory → Syncytiotrophoblast ————————————— 🔴 Part 1 – Genital tract & breast 📏 Fundal height: • 20 wk → at umbilicus 🎯 • 36–38 wk → under sternum ⬆️ • 40 wk → drops (engagement) ⬇️ 🔄 Dextrorotation: uterus rotates RIGHT ➡️, cervix deviates left near the ureter Softening signs (soft & violet): • Hegar → soft isthmus (6–8 wk) • Goodell → cervix • Chadwick → vagina • Jacquemier → vulva 💫 Braxton Hicks: irregular, painless, < 8 mmHg ⚠️ NO cervical dilatation 🔪 Lower segment forms from 4th month, and it's the site of: • CS incision • Rupture in obstructed labour • Placenta praevia 🩸 Uterine blood flow 500–700 mL/min = 12% of CO (vs 3–6%) Theca-lutein cysts: bilateral, high hCG, resolve after delivery ✅ Breast: • Changes are NOT a sure sign ❌ • Colostrum appears in month 3 ————————————— 🔵 Part 2 – CVS & blood ❤️ 📈 CO +50% by 20 wk | HR +20% | SVR −30% 📉 🛏 CO is highest in left lateral, lowest in supine 🩺 BP: • Lowest at 24–28 wk • 🚨 BP is NEVER normally elevated 🦵 Femoral venous pressure ×2–3, but CVP unchanged 😌 Supine hypotension (after 20 wk): • Earliest signs → ↑ HR, ↓ pulse pressure • Prevent with left lateral tilt ↩️ 💧 Blood: • Plasma ↑ 40–50% vs RBCs ↑ 20–30% → physiological anaemia • Pathological if Hb < 11–10.5 g/dL ⚠️ Prothrombotic state: • Fibrinogen doubles ✌️ • 🔑 Only factors XI & XIII fall ————————————— 🟢 Part 3 – Respiratory 🫁 Breathing is DEEPER, NOT FASTER • TV & MV ↑ 45% ⬆️ • RR & VC unchanged 🟰 • FRC ↓ 20% ⬇️ PaCO₂ ↓ to 32 mmHg → mild compensated alkalosis (pH 7.40–7.45) ━━━━━━━━━━━━━━ 🟠 Part 4 – GIT 🍽 Progesterone → heartburn 🔥, constipation, ↑ aspiration risk 📍 Appendix displaced upward & laterally ↗️ 🧬 Liver: • ALP ↑ 2–4× (placental) → normal ✅ • Palpable liver → abnormal ❌ ━━━━━━━━━━━━━━ 🟩 Part 5 – Urinary 💦 ⚡️ GFR +50% → creatinine ~0.5 mg% 💡 Highest normal in pregnancy ≈ lowest normal outside it 🔀 Ureters dilate R > L Pyelonephritis peak → 20–24 wk 🍬 Glucose threshold 195 → 155 mg/dL → glycosuria is common ————————————— 🟣 Part 6 – Endocrine & metabolism ⚖️ Thyroid: • TBG doubles → total T4 ↑ • 🔑 Free T4 unchanged • Any goitre → investigate 🔍 Weight gain 12.5 kg (fetus 3,400 g) 👶 🔥 BMR ↑ 15–20% 🍭 Insulin resistance ↑ ————————————— Quick Revision ⚡️ ➡️ Uterus rotates → Right ➡️ BP lowest → 24–28 wk ➡️ Only ↓ clotting factors → XI & XIII ➡️ Breathing → Deeper not faster ➡️ Normal ↑ ALP | Abnormal → palpable liver ➡️ TBG ↑ → free T4 unchanged بس كده خلصنا 🎉 بالتوفيق 💪✅

👮‍♂🖤 محاضرة Diagnosis of Pregnancy متنسقة ومتضاف عليها اي ملاحظات قالها الدكتور في الشرح