[Music]
hi there I'm dr. Veronica Gillespie and
today I'll be talking to you about
preconception care so let's go through a
case grace is a 25 year old gravity'
zero female who presents to your office
for preconception care she and her
husband are interested in conceiving in
six to eight months she has a history of
asthma but has never been intubated what
advice would you give this patient to
prepare for pregnancy well let's go
through the lecture to see so after this
lecture you will be able to describe the
key concepts that are related to
preconception care so let's first go
through some terminology you'll need to
know this to understand the other parts
of the lecture so first gravida t well
this is the number of times that a woman
has been pregnant
next asperity this is the number of
times that a woman has given birth now
this can be a little bit tricky so two
things to note about this if we have a
patient that has multiples because that
is only one pregnancy her gravida T does
not change so for example a patient that
gives birth to twins her avidity would
be one but a parody would be two you get
it two children for that one pregnancy
some other things to remember about
parity is sometimes it can be better
defined by a little acronym called T pal
so that's term birth subverts after 37
weeks preterm births births before 37
weeks abortions births that are before
20 weeks and then the number of live
births so another term is LMP or last
menstrual period you'll see this
abbreviated a lot and last mistral
period is very important in pregnancy
because it helps us to determine the
dispassion 'el age so EDD in EDC that's
the estimated date of delivery and the
estimated date of confinement these
terms are used interchangeably and this
tells us when we expect a patient to
deliver so this would be 40 weeks of
pregnancy and then GA is a gestational
age so that's how many weeks and days a
patient is pregnant throughout their
pregnancy again these terms are really
important as we go through the rest of
the lecture so when we start thinking
about preconception care one of the big
points that we want
make sure to make that our patients are
aware of its folic acid we also
recommend prenatal vitamins but the big
part of the prenatal vitamin that our
patients need is the folic acid it's
really important that this begins about
three months prior to conception and
folic acid is really important to
prevent neural tube defects the amount
that we recommend is 400 micrograms for
normal pregnancy however for women that
have had a pregnancy that was affected
by a neural tube defect or if they're
taking medications that can make their
folic acid lower we expect them to take
4 milligrams so their medical problems
that we often have to address in
pregnancy and the goal of preconception
care is to make sure we're optimizing
medical problems to decrease maternal
and fetal morbidity and mortality so
we'll go through a couple of medical
problems here so one of those issues
that we need to address is chronic
hypertension so it's really important to
note that in pregnancy in the first and
second trimester blood pressure often
decreases so for patients that are on
chronic hypertension medications they
may not need them in the beginning of
pregnancy and they may need them later
on in the pregnancy third trimester
blood pressures usually go back to pre
pregnancy levels
so speaking of medications we need to
review a patient's medications prior to
pregnancy to make sure their medication
is safe for pregnancy so for example
life scenario that's an ACE inhibitor
that can often cause renal agenesis and
so when patients come in to see us
before pregnancy we need to change them
over to a medication that is safe such
as labetalol alpha method opa or Necedah
teen the other thing we need to make
sure patients are aware of is that
chronic hypertension and pregnancy
increases their problems throughout the
pregnancy one notably is preeclampsia
the others preterm labor and especially
blood pressures are not controlled they
have an increased risk of placental
abruption so moving on from chronic
hypertension to diabetes diabetes is a
medical problem that we often have to
address prior to pregnancy as well in
general if patients have diabetes they
have risk to the pregnancy such as
congenital malformations cyclogenesis
being the most common increased risk of
pregnancy loss increased risk of fetal
macrosomia meaning a big baby or they
can have growth restriction because
diabetes can affect those vessels going
to the placenta they also have an
increased risk of diabetes diabetes
ketoacidosis especially if their blood
sugars are not controlled and overall
this increases maternal as well as
perinatal morbidity and mortality so if
we think back to the case that we had
our patient was 25 years old and she had
a history of asthma that she had never
been intubated so that's good to know
that her asthma has been pretty much
controlled throughout her lifetime
however asthma is a tricky tricky
disease and pregnancy for women a third
of the four third of women their asthma
gets worse in pregnancy for a third of
women their asthma stays the same and
for a third the asthma gets better we
don't really know why this happens it
may have to do with the increased
secretions that happen throughout
pregnancy but again this is a clinical
purl that's important to note for women
to have asthma in pregnancy so going
back to our patient grace remember she's
a 25 year old patient that's coming in
for preconception care we need to make
sure that she's taken folic acid as
she's looking to conceive in six to
eight months and we need to address her
history of asthma making sure that she's
aware that her asthma may get worse in
pregnancy it may stay the same and it
may get better
[Music]
you